Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis

Abstract

Background and PurposeSeveral risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools.MethodsWe searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data.ResultsWe identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).ConclusionsOur meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

Evaluation of Intracerebral Hemorrhage Functional Outcome Score informativeness for identification of short-term vital outcome in patients with spontaneous supratentorial intracerebral haemorrhage

“…The obtained data are consistent with the results of other studies which have proved that the initial level of neurological deficit, the cerebral syndrome severity [6,9,13], ICH volume [10][11][12] and the secondary IVH presence [14] influence had been revealed as determining factors for the vital prognosis. Detected increased blood glucose level in patients with unfavourable outcome is consistent with the study of S. V. Rogoza (2015) [2], who has claimed the connection between stress hyperglycemia and the worst SSICH outcome.…”

Prognostic models for complete recovery in ischemic stroke: a systematic review and meta-analysis

“…However, while the discrimination performance of their prognostic models varied from poor to good, calibration performance was not considered. The first study was a systematic review of prognostic tools for early mortality in hemorrhagic stroke [ 24 ]. The authors selected 11 articles (12 prognostic tools), but validation data were reported for only one of the prognostic tools.…”

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

“…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].…”

“…Результати. Значення сумарного бала ≥2 за шкалою Hemphill-ICH та ≥8 по ICH-GS асоційовані з підвищенням ризику летального результату відповідно в 7,1 [2,[8][9][10][11][12][13][14][15][16][17][18],0] (р < 0,01) і 4,4 [2,2-9,3] раза (р < 0,01). Шкала Hemphill-ICH характеризується вищою інформативністю для прогнозування вітального прогнозу виходу гострого періоду МГСІ (AUC = 0,84) порівняно зі шкалою ICH-GS (AUC = 0,78, p < 0,05).…”