A novel risk score to predict 1-year functional outcome after intracerebral hemorrhage and comparison with existing scores

Ji, Ruijun; Shen, Haipeng; Pan, Yuesong; Wang, Penglian; Liu, Gaifen; Wang, Yilong; Li, Hao; Zhao, Xingquan

doi:10.1186/cc13130

Cited by 88 publications

(91 citation statements)

References 32 publications

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“…The mean age of onset among patients of HA-related ICH in this study was younger than that reported by Meretoja et al 5 (60 years versus 66 years), which could explain the relatively better survival rate. 3 However, patients with CAA-related ICH in this study had far larger hematoma than those reported by Meretoja et al 5 (28 mL versus 14 mL), which could contribute to the worse survival. 3,7 Some noteworthy limitations to this study should be mentioned.…”

Section: Discussioncontrasting

confidence: 59%

“…3 However, patients with CAA-related ICH in this study had far larger hematoma than those reported by Meretoja et al 5 (28 mL versus 14 mL), which could contribute to the worse survival. 3,7 Some noteworthy limitations to this study should be mentioned. First, this study was conducted in a single tertiary medical center with Chinese population that has been shown to have a higher risk of ICH than white one.…”

Section: Discussioncontrasting

confidence: 59%

“…In this study, patients with the 2 pathogeneses were more likely to experience ICH ≥30 mL (59.6% and 66.4%, respectively), intraventricular hemorrhage (50.9% and 65.5%, respectively), multiple ICH (15.3% and 14.5%, respectively), higher median National Institute of Health stroke scale scores (20 and 24, respectively), and lower median Glasgow Coma Scale (9 and 8, respectively), which have been proven as poor prognosticators for ICH. 3,7,32 In addition to the contribution of ICH status to long-term outcomes, comorbidities in the systemic disease subtype, as well as heart conditions or high rate of infarction after medication-related subtype, all contribute to the poor prognosis. As reported by Meretoja et al, 5 the survival curves obtained from the SMASH-U classification system revealed similar survival rates among patients with HA-and CAA-related ICH.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Obtaining an pathogenetic diagnosis of ICH is crucial to the accuracy of predictions related to prognosis and the prevention of recurrent ICH. Numerous scoring systems have been proposed for predicting the outcome of ICH 3,4 ; however, only a few of these are based on pathogenetic classification. 5,6 The SMASH-U (structural vascular lesions, medication, cerebral amyloid angiopathy, systemic disease, hypertension, or undetermined) classification system is one such method, in which ICH pathogeneses are classified according to the following: structural lesions, medication related, amyloid angiopathy, systemic disease, hypertension, and undetermined pathogenesis.…”

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confidence: 99%

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Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Yeh

Tang

Tsai

et al. 2014

Stroke

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Background and Purpose-Pathogenetic classification of intracerebral hemorrhage (ICH), using systems such as SMASH-U (structural vascular lesions, medication, cerebral amyloid angiopathy [CAA], systemic disease, hypertension, or undetermined), is important in predicting functional outcomes and mortality in patients with ICH. This study aimed to compare pathogenetic subtypes between the first and recurrent ICH. Methods-This study obtained data related to 4578 consecutive acute patients with ICH from the National Taiwan University Hospital Stroke Registry during January 1995 to December 2013. Using the SMASH-U method, patients were classified into 6 subtypes. We then analyzed the outcomes of first-ever ICH cases and pathogenetic classification of recurrent ICH. Results-Among 3785 patients who experienced first-ever ICH (male, 63.3%; mean age, 58.7±17.0 years), the most common cause was hypertensive angiopathy (54.9%), followed by CAA (12.2%), systemic disease (12.1%), undetermined (10.1%), structural vascular lesions (7.8%), and medication related (2.9%). In 185 cases of recurrent ICH, pathogenetic differences between the 2 ICH events were observed in 34 (18.4%) cases, most of which were CAA to hypertensive angiopathy (n=10) or vice versa (n=7). The rates of ICH recurrence were highest for systemic disease-related and CAA-related ICH at 1, 5, 10, and 15 years after the indexed ICH event. Conclusions-In

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Section: Discussioncontrasting

confidence: 59%

Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Yeh

Tang

Tsai

et al. 2014

Stroke

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“…As a result of the fact that hematoma volume is an important prognostic predictor after ICH, 21,22 we separately developed 2 models with (ICH-APS-B) and without (ICH-APS-A) hematoma volume to test the added value of hematoma volume measure.…”

Section: Ji Et Al Risk Score To Predict Sap After Ich 2621mentioning

confidence: 99%

Risk Score to Predict Hospital-Acquired Pneumonia After Spontaneous Intracerebral Hemorrhage

Ji¹,

Shen²,

Pan³

et al. 2014

Stroke

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S pontaneous intracerebral hemorrhage (ICH) accounts for 10% to 15% of all strokes and is one of the leading causes of stroke-related mortality and morbidity worldwide. Patients with ICH are generally at risk of developing stroke-associated pneumonia (SAP) during acute hospitalization. Evidence has shown that SAP not only increases the length of hospital stay (LOS) and medical cost 1,2 but also is an important risk factor of mortality and morbidity after acute stroke. 3,4 Several risk factors for SAP have been identified, such as older age, 4-12 male sex, 5,6,10,11,13 current smoking, 12 diabetes mellitus, 6 hypertension, 14 atrial fibrillation, 7,10,12 congestive heart failure, 7,12,13,15 chronic obstructive pulmonary disease, 8,[12][13][14] preexisting dependency, 8,12,13,16 stroke severity, 5,6,8,12,17,18 dysphagia, [8][9][10][11][12]14,[18][19][20] and blood glucose. 12 Meanwhile, based on these risk factors, a few risk models have been developed for SAP after acute ischemic stroke. [8][9][10][11][12] Currently, no valid scoring system is available for predicting SAP after ICH in routine clinical practice or clinical trial. We hypothesized that there might be some common grounds for the development of pneumonia after acute ischemic stroke and ICH, and those predictors for SAP after acute ischemic stroke might also be useful for predicting SAP after ICH. For clinical practice, an effective risk-stratification and prognostic model for SAP after ICH would be helpful to identify vulnerable patients, allocate relevant medical resources, and implement tailored preventive strategies. In addition, for clinical trial, it could be used in nonrandomized studies to control for case-mix variation and in controlled studies as a selection criterion.Background and Purpose-We aimed to develop a risk score (intracerebral hemorrhage-associated pneumonia score, ICH-APS) for predicting hospital-acquired stroke-associated pneumonia (SAP) after ICH. Methods-The ICH-APS was developed based on the China National Stroke Registry (CNSR), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Variables routinely collected at presentation were used for predicting SAP after ICH. For testing the added value of hematoma volume measure, we separately developed 2 models with (ICH-APS-B) and without (ICH-APS-A) hematoma volume included. Multivariable logistic regression was performed to identify independent predictors. The area under the receiver operating characteristic curve (AUROC), Hosmer-Lemeshow goodness-of-fit test, and integrated discrimination index were used to assess model discrimination, calibration, and reclassification, respectively. Results-The SAP was 16.4% and 17.7% in the overall derivation (n=2998) and validation (n=2000) cohorts, respectively.A 23-point ICH-APS-A was developed based on a set of predictors and showed good discrimination in the overall derivation (AUROC, 0.75; 95% confidence interval, 0. Ji et al Risk Score to Predict SAP After ICH 2621In the study, we aimed to ...

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One-Year Outcome Trajectories and Factors Associated with Functional Recovery Among Survivors of Intracerebral and Intraventricular Hemorrhage With Initial Severe Disability

et al. 2022

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IMPORTANCE Patients who survive severe intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) typically have poor functional outcome in the short term and understanding of future recovery is limited.OBJECTIVE To describe 1-year recovery trajectories among ICH and IVH survivors with initial severe disability and assess the association of hospital events with long-term recovery. DESIGN, SETTING, AND PARTICIPANTSThis post hoc analysis pooled all individual patient data from the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage phase 3 trial (CLEAR-III) and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE-III) phase 3 trial in multiple centers across the US, Canada, Europe, and Asia. Patients were enrolled from August 1, 2010, to September 30, 2018, with a follow-up duration of 1 year. Of 999 enrolled patients, 724 survived with a day 30 modified Rankin Scale score (mRS) of 4 to 5 after excluding 13 participants with missing day 30 mRS. An additional 9 patients were excluded because of missing 1-year mRS. The final pooled cohort included 715 patients (71.6%) with day 30 mRS 4 to 5. Data were analyzed from July 2019 to January 2022.EXPOSURES CLEAR-III participants randomized to intraventricular alteplase vs placebo. MISTIE-III participants randomized to stereotactic thrombolysis of hematoma vs standard medical care.MAIN OUTCOMES AND MEASURES Primary outcome was 1-year mRS. Patients were dichotomized into good outcome at 1 year (mRS 0 to 3) vs poor outcome at 1 year (mRS 4 to 6). Multivariable logistic regression models assessed associations between prospectively adjudicated hospital events and 1-year good outcome after adjusting for demographic characteristics, ICH and IVH severity, and trial cohort. RESULTSOf 715 survivors, 417 (58%) were male, and the overall mean (SD) age was 60.3 (11.7) years. Overall, 174 participants (24.3%) were Black, 491 (68.6%) were White, and 49 (6.9%) were of other races (including Asian, Native American, and Pacific Islander, consolidated owing to small numbers); 98 (13.7%) were of Hispanic ethnicity. By 1 year, 129 participants (18%) had died and 308 (43%) had achievedmRS0to3.Inadjustedmodelsforthecombinedcohort,diabetes(adjustedoddsratio[aOR], 0.50; 95% CI, 0.26-0.96), National Institutes of Health Stroke Scale (aOR, 0.93; 95% CI, 0.90-0.96), severeleukoaraiosis(aOR,0.30;95%CI,0.16-0.54),pinealglandshift(aOR,0.87;95%CI,0.76-0.99]), acute ischemic stroke (aOR, 0.44; 95% CI, 0.21-0.94), gastrostomy (aOR, 0.30; 95% CI, 0.17-0.50), and persistent hydrocephalus by day 30 (aOR, 0.37; 95% CI, 0.14-0.98) were associated with lack of recovery. Resolution of ICH (aOR, 1.82; 95% CI, 1.08-3.04) and IVH (aOR, 2.19; 95% CI, 1.02-4.68) byday30wereassociatedwithrecoverytogoodoutcome.IntheCLEAR-IIImodel,cerebralperfusion pressure less than 60 mm Hg (aOR, 0.30; 95% CI, 0.13-0.71), sepsis (aOR, 0.05; 95% CI, 0.00-0.80), and prolonged mechanical ventilation (aOR, 0.96; 95% CI, 0.92-1.00 per day), and in MISTIE-III, need f...

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A novel risk score to predict 1-year functional outcome after intracerebral hemorrhage and comparison with existing scores

Cited by 88 publications

References 32 publications

Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Risk Score to Predict Hospital-Acquired Pneumonia After Spontaneous Intracerebral Hemorrhage

One-Year Outcome Trajectories and Factors Associated with Functional Recovery Among Survivors of Intracerebral and Intraventricular Hemorrhage With Initial Severe Disability

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