Abstract
PurposeNo strongevidenceofefficacycurrently exists for different intracerebral hemorrhage (ICH) scoring system in predicting the prognosis of ICH in the Chinese population. This study aimed to test the accuracyof the ICH score and the ICH grading scale (ICH-GS) score in predicting the favorable prognosis in a large cohort of ICH patients in China.MethodsThis study was a multicenter, prospective cohort study. Patients diagnosed with ICH between September 2007 and August 2008 from the nationwide China National Stroke Registry (CNSR) databasewere screened andenrolled in this study. Demographics of the patients, treatments, mortalityas well as the clinic and radiologic findings of ICH were collected.AnICH score and anICH-GS score were evaluated for all the patients atadmission. Follow-ups were conducted by phone at 3, 6 and 12 months after ICH onset. The modified Rankin scale (mRS) score was used to evaluate favorable functional outcome and was obtained at hospital dischargeand duringthe 3-, 6- and 12-month follow-up visits.ResultsThere were 410 (12.6%) in-hospitalmortalityout of a total of 3,255 ICH patients. Thevalues of the Area Under Curve (AUC)at discharge, 3-, 6- and 12-month follow-up for ICH score were 0.72, 0.76, 0.76 and 0.75, respectively; whilethe numbers for the ICH-GS score were 0.71, 0.77, 0.78 and 0.78, respectively. At 6-month and 12-month follow-up, the ICH-GS score presented a significant better value in predicting favorable prognosis than did the ICH score (P=0.0003 and <0.0001, respectively).ConclusionBoth the ICH and ICH-GS scores were effective inaccurately predicting the favorable functional outcome of ICH in the Chinese population. For mid-term and long-term prediction, the ICH-GS score was superiorover the ICH score.
Highlights
Intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes in western countries and is one of the leading causes of death and disability worldwide[1,2,3,4]
It is essential to develop a scale model that can accurately predict the prognosis of ICH based solely on the demographics of patients and the severity of the hemorrhage so that the physicians can use the scale to assess the impact of risk factors and the therapeutic efficacy of different treatment modalities[6]
Of all the 22,216 patients enrolled in China National Stroke Registry (CNSR), 5,136 were diagnosed with ICH and were screened for eligibility for this study. 1,881 of them were excluded because of: 1) 881 patients did not have the measurement of hematoma; 2) 138 patients had primary intraventricular hemorrhage (IVH); 3) 12 patients presented as intracranial tumor with hemorrhagic stroke; 4) 261 patients had disabilities prior to current incident of ICH; 5) 308 patients did not consent tothe follow-ups; 6) 281 patients lost follow-ups
Summary
Intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes in western countries and is one of the leading causes of death and disability worldwide[1,2,3,4]. Multiple risk factors of the disease and the pathophysiology process of the secondary neurologic injuries of ICH have been well recognizedby the scientific community[4,5].physicians are still facing constant challenges in making treatment decisions forthe ICH patients. It is essential to develop a scale model that can accurately predict the prognosis of ICH based solely on the demographics of patients and the severity of the hemorrhage so that the physicians can use the scale to assess the impact of risk factors and the therapeutic efficacy of different treatment modalities[6]. Several scale model shave been developed and the ICH score and the ICH-GS score (Table S1) are among the most commonly used models to date.Both the ICHscore and the ICH-GS score have been well recognized in the Western world as valuable predictors of the prognosis of ICH. Their performances in large Chinese populations have not been examined
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