Predicting Mortality in Spontaneous Intracerebral Hemorrhage

Abstract

Background and Purpose-A clinical grading scale for intracerebral hemorrhage (ICH), formally ICH score, was recently developed showing to predict 30-day mortality in a simple and reliable manner. The aim of the present study was to validate the original ICH (oICH) score in an independent cohort of patients from a developing country assessing 30-day mortality and 6-month functional outcome and whether its modifications can improve prediction. Methods-Consecutive patients admitted with acute ICH between January 1, 2003, and July 31, 2004, were prospectively included. oICH score was applied and 2 modified ICH (mICH) scores were created with the same variables, except localization, of the oICH score but with different cutoff values. Outcome was assessed as 30-day mortality and 6-month good outcome (Glasgow Outcome Scale [GOS] 4 to 5). Results-A total of 153 patients were included during study period. Thirty-day mortality rate was 34.6% (nϭ53), and 59 patients (38.6%) had good functional outcome (GOS 4 to 5) at 6 months. The oICH and mICH scores predicted mortality equally well. According to Youden's index (J), the oICH score was a reliable predictor for mortality (Jϭ0.59) but less reliable for predicting good outcome (Jϭ0.54). The mICH scores were equal in predicting mortality but better for predicting good outcome than the oICH score (Jϭ0.60). Conclusions-oICH score also confirms its validity in a socially and culturally different population. Modifications of oICH do not improve its 30-day mortality prediction but improve its ability to predict good functional outcome at 6 months.

Relationship between Baseline White Blood Cell and C-Reactive Protein with Mortality in Patients with Spontaneous Intracerebral Hemorrhage

“…To avoid confounding factors in the determination of inflammatory markers, we also excluded patients with a history of acute or chronic infections (≤4 weeks prior to sICH) at admission, concurrent major renal or hepatic disease, cancer, chronic or acute inflammatory diseases, surgery or major trauma in the previous month and those with obvious signs and clinical evidence of acquired in-hospital infection (n=62) (Figure 1). A detailed description of our study methodology has been published previously [17].…”

“…All patients were screened according to a strict protocol consisting of a complete medical history, a full neurological examination, standardized blood tests, at least 1 and usually 2 CT scans of the brain [17]. Surgical criteria were established according to the algorithm of decision in force to authors' institutions based on the guidelines of Stroke Council of the American Heart Association [2] and European Stroke Initiative recommendations (Appendix I) [18].…”

“…We were able to obtain current information on all included patients. All definitions and outcome diagnostic criteria were previously reported and validated by a study physician [17,22,29]. The evaluators were blinded to information regarding inflammation markers that were not used to modify current treatment both during in-hospital and follow-up period.…”

“…Age (per 10-year increase), oICH scores (per 1-point increase), glucose concentration (per 1.0 mmol/l increase) and sICH hematoma volume (per 1 cc increase) were entered into the Cox proportional hazard models as continuous variables. All the other variables were included as categorical dichotomized variables as previously described [17].…”

Transplantation of Neural Stem Cells That Overexpress Sod1 Enhances Amelioration of Intracerebral Hemorrhage in Mice

“…The prognosis of ICH is poor, with an overall 30-day mortality rate of B40%. 1 Most survivors experience persistent, severe neurologic deficits. 2 Medical therapy for ICH, such as mechanical removal of the hematoma, pharmacological prevention of edema formation, and reduction in intracranial pressure, shows only limited effectiveness.…”