Establishment of prediction score for hematoma expansion after intracerebral hemorrhage

Abstract

Background: Identification of intracerebral hemorrhage (ICH) patients at risk of hematoma expansion(HE) could facilitate the selection of candidates likely to benefit from therapies aiming to minimize ICH growth. We, therefore, aimed to develop a prediction score for HE that can be quickly used during the critical phase. Methods: A retrospective analysis of clinical features of 317 ICH patients in the Second Affiliated Hospital of Soochow University from January, 2016 to May, 2018 was conducted. Independent risk factors of HE were obtained according to multiple logistic regression, and a prediction score was established and preliminarily evaluated. Results: History of anticoagulants, ultraearly hematoma growth≥2.7ml/h, GCS≤8, and non-enhanced CT signs (island sign, black hole sign, blend sign, niveau formation) exist one or more, were independent risk factors for HE (P <0.05).The C statistics of score was 0.854 (95%CI, 0.803~0.904); P < 0.001); calibration was outstanding (c2=3.323, P = 0.344); decision curve analysis showed the score was safe and reliable, with high net benefit. After dichotomized, the sensitivity, specificity and accuracy of the high-risk group (score≥4.5) were 0.77, 0.85 and 0.83, respectively. Conclusion The score can accurately identify high-risk individuals with HE, swift guide treatment decisions, and can also be used in clinical trials. Keywords: Intracerebral hemorrhage; Hematoma expansion; Non-enhanced CT; Prediction; Score.