New Prediction Models of Functional Outcome in Acute Intracerebral Hemorrhage: The dICH Score and uICH Score.

Wen-Song Yang,Qi Li,Xin-Hui Li,Shu-Qiang Zhang,Zhi-Wei Zhang,Xin-Ni Lv,Lan Deng,Li-Bo Zhao,Xiao Wei,Qing-Jun Liu,Peng Xie,Yi-Qing Shen,Xiong-Fei Xie

doi:10.3389/fneur.2021.655800

Abstract

Objectives: The original intracerebral hemorrhage (oICH) score is the severity score most commonly used in clinical intracerebral hemorrhage (ICH) research but may be influenced by hematoma expansion or intraventricular hemorrhage (IVH) growth in acute ICH. Here, we aimed to develop new clinical scores to improve the prediction of functional outcomes in patients with ICH.Methods: Patients admitted to the First Affiliated Hospital of Chongqing Medical University with primary ICH were prospectively enrolled in this study. Hematoma volume was measured using a semiautomated, computer-assisted technique. The dynamic ICH (dICH) score was developed by incorporating hematoma expansion and IVH growth into the oICH score. The ultra-early ICH (uICH) score was developed by adding the independent non-contrast CT markers to the oICH score. Receiver operating characteristic curve analysis was used to compare performance among the oICH score, dICH score, and uICH score.Results: There were 310 patients in this study which included 72 patients (23.2%) with hematoma expansion and 58 patients (18.7%) with IVH growth. Of 31 patients with two or more non-contrast computed tomography markers, 61.3% died, and 96.8% had poor outcomes at 90 days. After adjustment for potential confounding variables, we found that age, baseline Glasgow Coma Scale score, presence of IVH on initial CT, baseline ICH volume, infratentorial hemorrhage, hematoma expansion, IVH growth, blend sign, black hole sign, and island sign could independently predict poor outcomes in multivariate analysis. In comparison with the oICH score, the dICH score and uICH score exhibited better performance in the prediction of poor functional outcomes.Conclusions: The dICH score and uICH score were useful clinical assessment tools that could be used for risk stratification concerning functional outcomes and provide guidance in clinical decision-making in acute ICH.

Highlights

Intracerebral hemorrhage (ICH) is the second most common stroke subtype, high in mortality and morbidity [1]
We developed the dynamic ICH score by incorporating hematoma expansion and intraventricular hemorrhage (IVH) growth into the original ICH (oICH) score and further established the uICH score by adding the independent NCCT markers to the oICH score
Patients with poor outcomes were more likely to have the presence of blend sign, black hole sign, CT hypodensities, and island sign

Summary

Introduction

Intracerebral hemorrhage (ICH) is the second most common stroke subtype, high in mortality and morbidity [1]. Independent predictors of poor functional outcomes included age, hematoma volume, intraventricular hemorrhage (IVH), Glasgow Coma Scale (GCS) score, and infratentorial hemorrhage [3, 4]. Acute ICH is a dynamic process, such that ∼30% of patients will experience early hematoma expansion [7, 8]. IVH growth has been reported in ∼20% of patients with ICH [9]. Recent studies suggested that both early hematoma expansion and IVH growth were independently associated with poor outcomes [7,8,9,10]. The predictive accuracy of the oICH score may be influenced by hematoma expansion or IVH growth in acute ICH. To ensure optimal patient care, clinicians require accurate information to perform effective risk stratification concerning patient outcomes

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