Risk Factors of In-Hospital Mortality of Intracerebral Hemorrhage and Comparison of ICH Scores in a Taiwanese Population

Abstract

Background and Purpose: Intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality. This study aimed to explore the risk factors associated with mortality and unfavorable outcome of ICH in Taiwan and to compare the predictive power with the existing ICH scores. Methods: Medical records of the ICH patients consecutively admitted to a regional hospital between January 2003 and December 2006 were reviewed retrospectively. The demographics, outcome, clinical and radiological characteristics were also analyzed. Results: A total of 61 among 285 (21.4%) ICH patients died during hospitalization. Diabetes mellitus, lower scores of initial Glasgow Coma Scale, initial ICH volume >30 ml, and intraventricular hematoma were identified as major independent risk factors associated with in-hospital mortality in the logistic regression model. In comparison to the predictive power for mortality and unfavorable outcome, Barthel Index <40 at discharge, the results showed no significant difference among the scores derived from our study, the ICH score by Hemphill and the modified ICH score developed in Taiwan. Conclusions: Although these ICH scores developed with various measurements, no significant difference in predicting mortality and unfavorable functional outcomes was found. The results supporting the ICH score by Hemphill may provide a good prediction in acute outcome across ethnic groups.

Comparison of all 19 published prognostic scores for intracerebral hemorrhage

“…The best performing score, ICH-FOS, adds NIHSS as a measure of clinical neurological status and hyperglycemia on admission as a measure of uncontrolled diabetes [14]. Many of the scores include comorbidities, [18,[26][27][28] some include hyper-or hypotension, [16,27,29] and one prognostic score even includes out-of-hours arrival [18]. These factors probably affect the mortality after ICH, but they may not be well generalizable to all ICH patients.…”

“…The analyses were conducted using SPSS 20 (IBM corp., NY). For the statistical differences in the c-statistics, we used Z derived from ROC-kit v.1.0.3 software [12] (http://metz-roc.uchicago.edu/) with non- [22] 226 Yes Taichung, Taiwan [1] 180-day 180-day GOS 4-5, 180-day BI 55-100 2008 ICH outcome score (ICHOS) [29] 107 No Taoyan, Taiwan [1] 30-day -2009 Simplified ICH score (sICH) [27] 293 No Taichung, Taiwan [1] 30-day -2011 Landseed ICH score (LSICH) [28] 285 No Taoyan, Taiwan [1] In-hospital Discharge BI b40 2012 ICH index (ICHI) [34] 227 No Chongqing, China [1] In-hospital 2013 ICH functional outcome score (ICH-FOS) [14] 1953 No China (132) -1-year mRS 3-6 2013 GWTG-stroke score [18] parametric assumptions and U-statistic based method [13]. A two-sided p b 0.05 was considered significant.…”

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample

“…on inpatient mortality. In 2 studies diabetes mellitus was associated with poor outcomes 9,10 in ICH. In another study prior anticoagulation was associated with poor outcomes.…”

Prediction of early prognosis in intracerebral hematomas: STICH-2 prognosis score against Hemphill score

“…The Simplified ICH score (sICH) also takes the patient's hemodialysis dependency into account (23). The Landseed ICH score (LSICH), ICH functional outcome score (ICH-FOS) and the Cincinnati Model are other prognostic tools that have proven good prognostic qualities (24)(25)(26).…”