Original Intracerebral Hemorrhage Score for the Prediction of Short-Term Mortality in Cerebral Hemorrhage: Systematic Review and Meta-Analysis

Abstract

Objectives: To systematically assess the discrimination and calibration of the Intracerebral Hemorrhage score for prediction of short-term mortality in intracerebral hemorrhage patients and to study its determinants using heterogeneity analysis. Data Sources: PubMed, ISI Web of Knowledge, Scopus, and CENTRAL from inception to September 15, 2018. Study Selection: Adult studies validating the Intracerebral Hemorrhage score for mortality prediction in nontraumatic intracerebral hemorrhage at 1 month/discharge or sooner. Data Extraction: Data were collected on the following aspects of study design: population studied, level of care, timing of outcome measurement, mean study year, and mean cohort Intracerebral Hemorrhage score. The summary measures of interest were discrimination as assessed by the C-statistic and calibration as assessed by the standardized mortality ratio (observed:expected mortality ratio). Random effect models were used to pool both measures. Heterogeneity was measured using the I 2 statistic and explored using subgroup analysis and meta-regression. Data Synthesis: Fifty-five studies provided data on discrimination, and 35 studies provided data on calibration. Overall, the Intracerebral Hemorrhage score discriminated well (pooled C-statistic 0.84; 95% CI, 0.82–0.85) but overestimated mortality (pooled observed:expected mortality ratio = 0.87; 95% CI, 0.78–0.97), with high heterogeneity for both estimates (I 2 80% and 84%, respectively). Discrimination was affected by study mean Intracerebral Hemorrhage score (β = –0.05), and calibration was affected by disease severity, with the score overestimating mortality for patients with an Intracerebral Hemorrhage score greater than 3 (observed:expected mortality ratio = 0.84; 95% CI, 0.78–0.91). Mortality rates were reproducible across cohorts for patients with an Intracerebral Hemorrhage score 0–1 (I 2 = 15%). Conclusions: The Intracerebral Hemorrhage score is a valid clinical prediction rule for short-term mortality in intracerebral hemorrhage patients but discriminated mortality worse in more severe cohorts. It also overestimated mortality in the highest Intracerebral Hemorrhage score patients, with significant inconsistency between cohorts. These results suggest that mortality for these patients is dependent on factors not included in the score. Further studies are needed to determine these factors.

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

“…In patients with spontaneous ICH, a baseline severity score might be reasonable to provide a general framework for communication with the patient and their caregivers. 472,473 3: No Benefit B-NR 3. In patients with spontaneous ICH, a baseline severity score should not be used as the sole basis for forecasting individual prognosis or limiting life-sustaining treatment.…”

“…In patients with spontaneous ICH, administering a baseline measure of overall hemorrhage severity is recommended as part of the initial evaluation to provide an overall measure of clinical severity. [472][473][474] 2b B-NR 2. In patients with spontaneous ICH, a baseline severity score might be reasonable to provide a general framework for communication with the patient and their caregivers.…”

Variation in medical management and neurosurgical treatment of patients with supratentorial spontaneous intracerebral haemorrhage

“… 28 Nevertheless, it is important to note that commonly used prognostic scores vary widely in their ability to predict outcome accurately, with a c-statistic varying from 0.62-0.88 for the prediction of 3- and 12-month mortality, 22 and may be particularly less reliable for the highest scores that predict poor outcome. 24 Only few of these scores can predict functional outcome beyond 30 days after symptom onset. 22 Although our study showed a relatively low percentage of physicians using a prediction tool, the factors age and GCS score, which are important components in all prediction scores, were considered important factors to influence decision-making.…”

“…10,11,17,18 Prediction scores used in the acute phase have limited accuracy for the prediction of 30-day mortality and functional outcome, [19][20][21][22][23] and appear especially unreliable for the higher scores that predict poor outcome. 24 Furthermore, these prediction scores do not facilitate physicians in their choice for a certain treatment strategy. The decision to perform surgery for supratentorial sICH often depends on assumptions based on personal experiences.…”

Plasma and Intrapulmonary Pharmacokinetics, and Dosage Regimen Optimization of Linezolid for Treatment of Gram-Positive Cocci Infections in Patients with Pulmonary Infection After Cerebral Hemorrhage

“…The incidence of cerebral hemorrhage has increased in recent years, and patients with cerebral hemorrhage are often in critical condition and exhibit varying degrees of disturbance in consciousness. 1 , 2 Pulmonary infection is a common and serious complication in patients with cerebral hemorrhage, and it is also a primary cause of multiple organ failure and death. 1 , 2 Previous studies have shown that the efficacy and safety of the antibiotic linezolid, a cost-effective option, were superior to those of vancomycin, 3–7 These results suggested that linezolid should be the first-line antibiotic for treatment of methicillin-resistant Staphylococcus aureus ( MRSA ).…”