Retrospective study of long-term outcome after brain arteriovenous malformation rupture: the RAP score

Abstract

OBJECTIVE The authors aimed to design a score for stratifying patients with brain arteriovenous malformation (BAVM) rupture, based on the likelihood of a poor long-term neurological outcome. METHODS The records of consecutive patients with BAVM hemorrhagic events who had been admitted over a period of 11 years were retrospectively reviewed. Independent predictors of a poor long-term outcome (modified Rankin Scale score ≥ 3) beyond 1 year after admission were identified. A risk stratification scale was developed and compared with the intracranial hemorrhage (ICH) score to predict poor outcome and inpatient mortality. RESULTS One hundred thirty-five patients with 139 independent hemorrhagic events related to BAVM rupture were included in this analysis. Multivariate logistic regression followed by stepwise analysis showed that consciousness level according to the Glasgow Coma Scale (OR 6.5, 95% CI 3.1-13.7, p < 10), hematoma volume (OR 1.8, 95% CI 1.2-2.8, p = 0.005), and intraventricular hemorrhage (OR 7.5, 95% CI 2.66-21, p < 10) were independently associated with a poor outcome. A 12-point scale for ruptured BAVM prognostication was constructed combining these 3 factors. The score obtained using this new scale, the ruptured AVM prognostic (RAP) score, was a stronger predictor of a poor long-term outcome (area under the receiver operating characteristic curve [AUC] 0.87, 95% CI 0.8-0.92, p = 0.009) and inpatient mortality (AUC 0.91, 95% CI 0.85-0.95, p = 0.006) than the ICH score. For a RAP score ≥ 6, sensitivity and specificity for predicting poor outcome were 76.8% (95% CI 63.6-87) and 90.8% (95% CI 81.9-96.2), respectively. CONCLUSIONS The authors propose a new admission score, the RAP score, dedicated to stratifying the risk of poor long-term outcome after BAVM rupture. This easy-to-use scoring system may help to improve communication between health care providers and consistency in clinical research. Only external prospective cohorts and population-based studies will ensure full validation of the RAP scores' capacity to predict outcome after BAVM rupture.

S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture

“…5 ICH, ICH volume, intraventricular hemorrhage, and Glasgow Coma Scale have been associated with outcome in BAVM rupture. 1,6 In this retrospective cohort, S100B elevation appears to be a stronger prognostic marker than any of the imaging markers studied. S100Bmax48>0.5 µg/L demonstrated higher sensitivity and specificity than an ICH volume ≥60 mL in predicting in-hospital mortality.…”

“…Prognostic markers provide a basis for decision-making regarding the most appropriate level of care in neurocritically ill patients. 1 Prognosis is a major thematic domain of questioning by relatives of intensive care unit patients. 4 Providing relatives with high-quality prognostic information enhances their ability to actively participate in the decision-making process regarding aggressive therapeutic interventions.…”

Secondary S100B Protein Increase Following Brain Arteriovenous Malformation Rupture is Associated with Cerebral Infarction

“…Markers of initial severity following BAVM rupture as well as long-term outcome have been widely studied [1,[7][8][9]. In contrast, studies evaluating the impact of early complications (and their incidence) such as rebleeding or ischemia remain scarce [5,6,10].…”

Arteriovenous Malformations of the Posterior Fossa: Focus on Surgically Treated Patients Presenting with Hemorrhage

“…In this series, and also in the existing literature, it has been demonstrated that deep venous drainage poses a significant risk to poor outcome in surgically treated AVM patients. [21][22][23]…”