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Published on: April 23, 2021
Comparison of all 19 published prognostic scores for intracerebral hemorrhage
Jarno Satopää1, Satu Mustanoja2, Atte Meretoja2
1Department of Neurosurgery, Helsinki University Hospital, Clinical Neurosciences, Neurosurgery, University of Helsinki, Finland.
Insights
The National Institutes of Health Stroke Scale (NIHSS) predicts in-hospital death, while the ICH Functional Outcome Score (ICH-FOS) best predicts mortality for intracerebral hemorrhage (ICH) patients.
Area of Science:
- Neurology
- Clinical Medicine
- Biostatistics
Background:
- Intracerebral hemorrhage (ICH) poses a significant mortality risk.
- Numerous prognostic scores exist to predict ICH patient outcomes.
- Accurate prediction tools are crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the accuracy of 19 published prognostic scores for predicting mortality after ICH.
- To identify the optimal score for predicting 3-month, in-hospital, and 12-month mortality in ICH patients.
Main Methods:
- Retrospective analysis of 882 consecutive ICH patients.
- Evaluation of 19 prognostic scores using c-statistics, Youden index, sensitivity, specificity, and predictive values.
- Inclusion of all score components in a multivariable model to assess maximum predictive value.
Main Results:
- In-hospital mortality was 23.6%, 3-month mortality was 31.0%, and 12-month mortality was 35.3%.
- The National Institutes of Health Stroke Scale (NIHSS) performed well for in-hospital mortality.
- The ICH Functional Outcome Score (ICH-FOS) demonstrated the best performance for 3-month and 12-month mortality predictions (c-statistic 0.8802).
- A multivariable model incorporating all variables did not improve predictive accuracy (c-statistic 0.89).
Conclusions:
- The NIHSS is a valuable tool for quantifying in-hospital mortality risk in ICH.
- The ICH-FOS is the most accurate score for predicting longer-term mortality (3 and 12 months) after ICH.
- Clinicians can utilize these scores to better estimate prognosis in acute ICH patients.
Background And Aims:
We evaluated the accuracy of 19 published prognostic scores to find the best tool for predicting mortality after intracerebral hemorrhage (ICH).
Methods:
A retrospective single-center analysis of consecutive patients with ICH (n=1013). After excluding patients with missing data (n=131), we analyzed 882 patients for 3-month (primary outcome), in-hospital, and 12-month mortality. We analyzed the strength of the individual score components and calculated the c-statistics, Youden index, sensitivity, specificity, negative and positive predictive value (NPV and PPV) for the scores. Finally, we included every score component in a multivariable model to analyze the maximum predictive value of the data elements combined.
Results:
Observed in-hospital mortality was 23.6%, 3-month mortality was 31.0%, and 12-month mortality was 35.3%. For in-hospital mortality, the National Institutes of Health Stroke Scale (NIHSS) performed equally good as the best score for the other outcomes, the ICH Functional Outcome Score (ICH-FOS). The c-statistics of the scores varied from 0.6293 (95% CI 0.587-0.672) to 0.8802 (0.855-0.906). With all variables from all the scores in a multivariable regression model, the c-statistics did not improve, being 0.89 (0.867-0.913). Using the Youden index cutoff for the ICH-FOS score, the sensitivity (73%), specificity (90%), PPV (76%), and NPV (88%) for the primary outcome were good.
Conclusions:
A plethora of scores exists to help clinicians estimate the prognosis of an acute ICH patient. The NIHSS can be used to quantify the risk of in-hospital death while the ICH-FOS performed best for the other outcomes.
