Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain

Rodríguez-Fernández, Sonia; Castillo-Lorente, E.; Guerrero-López, F.; Rodríguez-Rubio, David; Aguilar-Alonso, Eduardo; Lafuente-Baraza, Jesús; Gómez-Jiménez, Francisco Javier; Mora-Ordóñez, Juan M.; Arias-Verdu, M. D.; Quesada-García, Guillermo; Arráez-Sánchez, Miguel Ángel; Rivera-Fernández, Ricardo

doi:10.1136/bmjopen-2018-021719

Cited by 16 publications

(12 citation statements)

References 41 publications

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“…Good prognostic accuracy of the ICH scale alone (with regard to early mortality) was demonstrated in the studied group; similar to the outcomes reported by authors of this scale, only patients who scored 4 on the ICH scale had a higher risk of mortality than that reported in the literature [ 19 , 25 , 27 , 28 ]. Also, patients with ICH score 1 or 3 admitted during off-hours (17% of all analysed groups) had a higher risk of death.…”

Section: Discussionsupporting

confidence: 87%

Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland

Nowakowska-Kotas

Waliszewska‐Prosół

Papier

et al. 2020

Emergency Medicine International

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Background. The mortality rate for spontaneous intracerebral haemorrhage (ICH) has remained high and stable for many years. The unfavourable prognostic factors include age, bleeding volume, location of the haematoma, high blood pressure, and disturbed consciousness on admission. Other risk factors associated with medical care also deserve attention. The study aimed to analyse the relationship between day of admission, concerning other prognostic factors, and short-term mortality in ICH, in a Polish specialist stroke unit. Methods. Medical records of 156 patients (74 males, 82 females, mean age 68.7 years) diagnosed with spontaneous ICH and admitted to a specialist stroke center were retrospectively analysed. Demographics, location, volume of bleeding, blood pressure values, and the Glasgow Coma Scale (GCS), as well as the day of admission, were determined. The relationships were analysed between these factors and 30-day mortality in the patients with ICH. Results. A total of 83 patients were admitted to the hospital during weekdays (Monday 8 am to Friday 3 pm) and 73 during weekends or holidays. Of these, 65 patients died within 30 days. Patients admitted at weekends initially presented with lower GCS scores. Admission on Saturday was associated with an increased risk of death (OR 3.38, 95% CI 1.2–9.48, p < 0.05 ), but after correction for clinical state measured with the GCS and ICH score, the association was no longer significant. Conclusions. The time and mode of admission were not associated with increased risk of short-term mortality in ICH patients. Prehospital care issues should be additionally considered as prognostic factors of the outcome.

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Section: Discussionsupporting

confidence: 87%

Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland

Nowakowska-Kotas

Waliszewska‐Prosół

Papier

et al. 2020

Emergency Medicine International

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“…The lack of success in modifying outcomes in patients with very large hematomas makes any potential predictor, apart from those included in the commonly used prognostic scores, unlikely to yield any consistent results [3]. The initial report of the ICH score published in 2001 ascribed mortality rates of 97% and 72% for ICH scores of 5 and 4 points, respectively, and these percentages seem to still be valid nowadays, in more performant ICU settings [4,22]. This is why future analysis of predictors of outcome in patients with ICH should probably focus on populations with less severe ICH scores at admission and less dramatic clinical course.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio as an Independent Predictor of In-Hospital Mortality in Patients with Acute Intracerebral Hemorrhage

et al. 2021

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Background and Objectives: Neutrophil-to-lymphocyte ratio (NLR), a very low cost, widely available marker of systemic inflammation, has been proposed as a potential predictor of short-term outcome in patients with intracerebral hemorrhage (ICH). Methods: Patients with ICH admitted to the Neurology Department during a two-year period were screened for inclusion. Based on eligibility criteria, 201 patients were included in the present analysis. Clinical, imaging, and laboratory characteristics were collected in a prespecified manner. Logistic regression models and receiver operating characteristics (ROC) curves were used to assess the performance of NLR assessed at admission (admission NLR) and 72 h later (three-day NLR) in predicting in-hospital death. Results: The median age of the study population was 70 years (IQR: 61–79), median admission NIHSS was 16 (IQR: 6–24), and median hematoma volume was 13.7 mL (IQR: 4.6–35.2 mL). Ninety patients (44.8%) died during hospitalization, and for 35 patients (17.4%) death occurred during the first three days. Several common predictors were significantly associated with in-hospital mortality in univariate analysis, including NLR assessed at admission (OR: 1.11; 95% CI: 1.04–1.18; p = 0.002). However, in multivariate analysis admission, NLR was not an independent predictor of in-hospital mortality (OR: 1.04; 95% CI: 0.9–1.1; p = 0.3). The subgroup analysis of 112 patients who survived the first 72 h of hospitalization showed that three-day NLR (OR: 1.2; 95% CI: 1.09–1.4; p < 0.001) and age (OR: 1.05; 95% CI: 1.02–1.08; p = 0.02) were the only independent predictors of in-hospital mortality. ROC curve analysis yielded an optimal cut-off value of three-day NLR for the prediction of in-hospital mortality of ≥6.3 (AUC = 0.819; 95% CI: 0.735–0.885; p < 0.0001) and Kaplan–Meier analysis proved that ICH patients with three-day NLR ≥6.3 had significantly higher odds of in-hospital death (HR: 7.37; 95% CI: 3.62–15; log-rank test; p < 0.0001). Conclusion: NLR assessed 72 h after admission is an independent predictor of in-hospital mortality in ICH patients and could be widely used in clinical practice to identify the patients at high risk of in-hospital death. Further studies to confirm this finding are needed.

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“…Reliability of the model for predicting the outcome was investigated with calibration curves and Hosmer–Lemeshow goodness‐of‐fit test [13–15]. Calibration refers to the agreement between the observed outcome frequencies and probabilities predicted by the model.…”

Section: Methodsmentioning

confidence: 99%

Reliability of the intracerebral hemorrhage score for predicting outcome in patients with intracerebral hemorrhage using oral anticoagulants

Fakiri

Uyttenboogaart

Houben

et al. 2020

Euro J of Neurology

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Background and purpose The intracerebral hemorrhage (ICH) score is the most widely used and validated prognostic model for estimating 30‐day mortality in ICH. However, the score was developed and validated in an ICH population probably not using oral anticoagulants (OACs). The aim of this study was to determine the performance of the ICH score for predicting the 30‐day mortality rate in the full range of ICH scores in patients using OACs. Methods Data from admitted patients with ICH were collected retrospectively in two Dutch comprehensive stroke centers. The validity of the ICH score was evaluated by assessing both discrimination and calibration in OAC and OAC‐naive patient groups. Results A total of 1752 patients were included of which 462 (26%) patients were on OAC. The 30‐day mortality was 54% for the OAC cohort and 34% for the OAC‐naive cohort. The 30‐day mortality was higher in the OAC cohort for ICH score 1 (33% vs. 12.5%; odds ratio, 3.4; 95% confidence intervals, 1.1–10.4) and ICH score 2 (53% vs. 26%; odds ratio, 3.2; 95% confidence intervals, 1.2–8.2) compared with the predicted mortality rate of the original ICH score. Overall, the discriminative ability of the ICH score was equally good in both cohorts (area under the curve 0.83 vs. 0.87, respectively). Conclusions The ICH score underestimated the 30‐day mortality rate for lower ICH scores in OAC‐ICH. When estimating the prognosis of ICH in patients using OAC, this underestimation of mortality must be taken into account.

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Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain

Cited by 16 publications

References 41 publications

Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland

Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland

Neutrophil-to-Lymphocyte Ratio as an Independent Predictor of In-Hospital Mortality in Patients with Acute Intracerebral Hemorrhage

Reliability of the intracerebral hemorrhage score for predicting outcome in patients with intracerebral hemorrhage using oral anticoagulants

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