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Prognostic Accuracy of Common Mortality Prognostic Scales in Very Old Patients with Intracerebral Haemorrhage
Rafael Batista1, Marta Pereira1, Deise Catamo Vaz1,2
1Medical Education Unit, Faculty of Medicine and Biomedical Sciences, Faro, Portugal.
Background:
Spontaneous intracerebral haemorrhage (SICH) is the most severe form of all stroke types. Stratification of SICH severity is important for group comparisons and treatment decisions. The existing prognostic scores for clinical prediction in SICH have not been specifically validated in the very old (≥75 years). Therefore, we aimed to evaluate the accuracy of different SICH vital prognostic scores in the very old.
Purpose:
To compare the short-term accuracy of three vital prognostic scores: Functional Outcome in Patients with Primary Intracerebral Haemorrhage (FUNC), Modified Emergency Department Intracerebral Haemorrhage (mEDICH) and the Intracerebral Haemorrhage Score ('ICH score') in patients aged 75 or older.
Methods:
Comparison of the discriminative performance of three SICH prognostic scores in a consecutive case series of patients ≥75 years. The prognostic discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Additionally, a binary logistic regression was conducted to determine independent prognostic factors associated with mortality.
Results:
The case-fatality was 40.6%. The AUROC and Younden index for the three scores was as it follows: 'ICH score' 0.882 and 0.648; mEDICH 0.867 and 0.571; FUNC 0.802 and 0.519. The main independent risk factors of death were presence of intraventricular extension (OR = 4.000,95% CI= 1.933-8.276), INR value (OR = 2.173, 95% CI = 1.146-4.117), haemorrhage volume (OR = 1.881, 95% CI = 1.029-3.440) and GCS (OR = 0.119, 95% CI = 0.060-0.236) for mEDICH. Haemorrhage volume (OR = 3.020, 95% CI = 1.806-5.050) and GCS (OR = 0.043, 95% CI = 0.013-0.151) for FUNC. Haemorrhage volume (OR = 4.950, 95% CI = 2.249-10.897) and intraventricular haemorrhage (OR = 3.811, 95% CI = 1.833-7.924) for 'ICH score'.
Conclusion:
The three scores ('ICH score', FUNC and mEDICH) showed an excellent capability of discriminating the group of elderly patients at risk of short-term death. Age per se may not be crucial for accurate discrimination of death in the group of elderly. Instead, the inclusion of available physiological markers of fragility would be more scientifically meaningful than age.
