Можливості клініко-нейровізуалізаційної верифікації прогнозу перебігу гострого періоду спонтанного супратенторіального внутрішньомозкового крововиливу на тлі консервативної терапії

Abstract

The aim of the study – to improve the diagnostic measures in patients with spontaneous supratentorial intracerebral hemorrhage through elaboration of the prognostic criteria for the early neurological deterioration on the ground of comparative analysis of clinical scales that evaluate the severity of patient’s condition. Materials and methods. Prospective, cohort investigation of 339 patients (mean age 64,8±0,6 years) in acute period of spontaneous supratentorial intracerebral hemorrhage was done. The diagnosis was made on the ground of clinical, neurovisualization examination. Initial patient’s condition severity was estimated by using the National Institute of Health Stroke Scale (NIHSS), Full Outline of UnResponsiveness (FOUR) Scale, Glasgow Coma Scale, original Intracerebral Hemorrhage Scale (oICH), modified Intracerebral Hemorrhage Scales (mICH-A, mICH-B), Intracerebral Hemorrhage Grading Scale (ICH-GS), Intracerebral Hemorrhage Functional Outcome Scale (ICH-FOS). The early neurological deterioration was used as a cumulative end-point. It was detected as onset of one or some events from the following during 24 hours from the admission on the ground of conservative therapy: 1) decrease of FOUR score ≥2; 2) increase of NIHSS score ≥4; 3) lethal outcome. Logistic regression and ROC-analysis were used for prognostic criteria elaboration. Results. Clinical neurological deterioration during 24 hours from admission was revealed in 99 (29,2%) patients. On the ground of univariate logistic regression analysis it was detected that the risk of early neurological deterioration in patients with spontaneous supratentorial intracerebral hemorrhage on the ground of conservative therapy is evaluated as the following summary score: oICH (OR (95% CІ) = 2,71 (2,07–3,55), р˂0,0001), mICH-A (OR (95% CІ) = 1,70 (1,50–1,93), р˂0,0001), mICH-B (OR (95% CІ) = 1,81 (1,57–2,09), р˂0,0001), ICH-GS (OR (95% CІ) = 1,91 (1,59–2,29), р˂0,0001) and ICH-FOS (OR (95% CI) = 1,40 (1,28–1,54), р˂0,0001). It was detected that mICH-A and mICH-B scales differ with higher AUC values compared with oICH, ICH-GS and ICH-FOS concerning early neurological deterioration prediction in patients with spontaneous supratentorial intracerebral hemorrhage. Conclusions. Early neurological deterioration predictors in patients with spontaneous supratentorial intracerebral hemorrhage during 24 hours from the admission are the mICH-A score >4 (sensitivity = 71,7%, specificity = 78,8%) and mICH-B score >2 (sensitivity = 82,8%, specificity = 63,8%)