Possibilities of clinical neuroimaging assessment scales using for patient severity in the onset of cerebral hemorrhagic supratentorial stroke to predict the outcome of the disease acute period

A A Kuznietsov

doi:10.14739/2310-1210.2018.1.121990

Abstract

The main purpose of the study was to determine the criteria for the vital and functional prognosis of the cerebral hemorrhagic supratentorial stroke (CHSS) acute period outcome based on the Hemphill Intracerebral Hemorrhage (Hemphill-ICH) Scale and ICH-Grading Scale (ICH-GS) in the onset of the disease.Materials and methods. A prospective, cohort, complex clinical and paraclinical study was conducted in 124 patients (72 men and 52 women, mean age 64.7 ± 1.1 years) with CHSS. This study included clinical assessment using National Institute of Health Stroke Scale and Glasgow Coma Scale, visualization of cerebral structures and integrated assessment of health state severity using the Hemphill-ICH Scale and ICH-GS. The functional outcome of the acute period was determined by the modified Rankin Scale.Results. The Hemphill-ICH Scale score ≥2 and ICH-GS score ≥8 are associated with an increased risk of CHSS acute period lethal outcome, at 7.1 [2.8–18.0] (P < 0.01) and 4.4 [2.2–9.3] times (P < 0.01), respectively. The Hemphill-ICH Scale is characterized by a higher informative value for CHSS acute period lethal outcome prediction (AUC = 0.84) in comparison with the ICH-GS (AUC = 0.78, P < 0.05). The ICH-GS is characterized by a higher informative value for the functional prognosis of CHSS acute period outcome (AUC = 0.69) in comparison with the Hemphill-ICH Scale (AUC = 0.61, P < 0.05).Conclusions. Predictors of CHSS acute period lethal outcome are Hemphill-ICH Scale score ≥ 2 and ICH-GS score ≥8. The Hemphill-ICH Scale score = 0 and ICH-GS score = 5 are the criteria for the favourable functional outcome of CHSS acute period (mRS score ≤3 on the 21st day). The informative value of the Hemphill-ICH Scale and ICH-GS is higher for the vital prognosis than for the functional prognosis of CHSS acute period outcome verification.

Highlights

Cerebral hemorrhagic stroke (CHS) is at leading positions as for the structure of death and disability causes in young and middle-aged people in most countries of the world [2,6,12]
In accordance with the Receiver operating characteristic (ROC) analysis, it has been established that the predictors of disease acute period lethal outcome are the Hemphill-ICH Scale score ≥ 2 (Se = 77.3 %, Sp = 77.5 %) and ICH-Grading Scale (ICH-GS) score ≥8 (Se = 54.6 %, Sp = 86.3 %)
It has been determined that the Hemphill-ICH Scale is characterized by a higher informative value for the vital prognosis of cerebral hemorrhagic supratentorial stroke (CHSS) acute period (AUC = 0.84) in comparison with the ICH-GS (AUC = 0.78, P < 0.05)

Summary

Introduction

Cerebral hemorrhagic stroke (CHS) is at leading positions as for the structure of death and disability causes in young and middle-aged people in most countries of the world [2,6,12]. Numerous studies have convincingly proved the connexion between the initial neurological deficiency level, structural changes in brain substance and the outcome of cerebral hemorrhagic supratentorial stroke (CHSS), which justifies the advisability of complex clinical-neuroimaging scales using in assessment of patient severity for verifying the prognosis [3,7,8,11,14]. In accordance with the results of the meta-analysis, the Hemphill Intracerebral Hemorrhage (Hemphill-ICH) Scale and ICH-Grading Scale (ICH-GS) are the most informative for the prediction of patient survival during the first half of the year after CHS [9]. Unified criteria for the CHSS acute period outcome prediction along with the optimal sensitivity (Se) and specificity (Sp) ratio, which would take into account the results of the assessment on the indicated scales, are currently unavailable

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