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ADVISING score: a reliable grading scale based on injury and response for intracerebral haemorrhage
Yan Wan1, Hongxiu Guo1, Shaoli Chen1
1Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
A new ADVISING score predicts functional dependence after intracerebral haemorrhage (ICH). This reliable tool uses nine multisystem markers to assess stroke outcomes, improving upon existing methods.
Area of Science:
- Neurology
- Clinical Medicine
- Biostatistics
Background:
- Intracerebral haemorrhage (ICH) is a severe stroke type with high morbidity and mortality.
- Predicting functional dependence after ICH is crucial for patient management and outcomes.
Purpose of the Study:
- To develop and validate a novel clinical scoring system, ADVISING, for predicting 90-day functional dependence after ICH.
- To incorporate multisystem markers into a predictive score for improved accuracy.
Main Methods:
- Data from the Chinese Cerebral Hemorrhage: Mechanism and Intervention study were analyzed.
- Multivariable logistic regression identified factors associated with 90-day functional dependency (modified Rankin Scale ≥3).
- The ADVISING score was developed and validated in training (2111 patients) and external (733 patients) cohorts.
Main Results:
- Nine variables (age, hematoma location/volume, NIHSS, AST, INR, NLR, glucose, GFR) formed the ADVISING score.
- The ADVISING score demonstrated good discrimination and calibration in both cohorts (C-statistics 0.866 and 0.884).
- The ADVISING score outperformed five existing ICH scores in predictive performance (p<0.001).
Conclusions:
- The ADVISING score is a reliable and effective tool for predicting 90-day functional dependence after intracerebral haemorrhage.
- This novel score offers improved prediction accuracy compared to existing clinical scores.
Background:
Intracerebral haemorrhage (ICH) is the most devastating form of stroke causing high morbidity and mortality. We aimed to develop a novel clinical score incorporating multisystem markers to predict functional dependence at 90 days after ICH.
Methods:
We analysed data from Chinese Cerebral Hemorrhage: Mechanism and Intervention study. Multivariable logistic regression analysis was used to identify the factors associated with 90-day functional dependency (the modified Rankin Scale ≥3) after ICH and develop the ADVISING scoring system. To test the scoring system, a total of 2111 patients from Hubei province were included as the training cohort, and 733 patients from other three provinces in China were included as an external validation cohort.
Results:
We found nine variables to be significantly associated with functional dependency and included in the ADVISING score system: age, deep location of haematoma, volume of haematoma, National Institutes of Health Stroke Scale, aspartate transaminase, international normalised ratio, neutrophil-lymphocyte ratio, fasting blood glucose and glomerular filtration rate. Individuals were divided into 12 different categories by using these nine potential predictors. The proportion of patients who were functionally dependent increased with higher ADVISING scores, which showed good discrimination and calibration in both the training cohort (C-statistic, 0.866; p value of Hosmer-Lemeshow test, 0.195) and validation cohort (C-statistic, 0.884; p value of Hosmer-Lemeshow test, 0.853). The ADVISING score also showed better discriminative performance compared with the other five existing ICH scores (p<0.001).
Conclusions:
ADVISING score is a reliable tool to predict functional dependency at 90 days after ICH.
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