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Clinical, Laboratory, and CT Morphological Factors Associated with 3-Month Functional Outcomes in Spontaneous
Mustafa Harun Şahin1, Özhan Özcan2, Oğuzhan Kurşun3
1Department of Neurology, Balikesir Ataturk City Hospital, 10100 Balikesir, Türkiye.
Insights
Predicting outcomes for spontaneous intracerebral hemorrhage (ICH) is crucial. This study found that neurological severity, hematoma volume, and CT scan findings like hypodensities predict poor functional outcomes.
Area of Science:
- Neurology
- Radiology
- Biomedical Engineering
Background:
- Spontaneous intracerebral hemorrhage (ICH) leads to significant mortality and disability.
- Accurate prediction of functional outcomes is essential for patient management.
Purpose of the Study:
- To identify independent clinical, laboratory, and imaging predictors of 3-month functional outcome in spontaneous ICH patients.
- To evaluate the predictive performance of these factors compared to existing prognostic scores.
Main Methods:
- Retrospective cohort study of 337 spontaneous ICH patients.
- Analysis included clinical data, laboratory parameters, non-contrast CT (NCCT) morphological markers, hematoma volume, and prognostic scores (ICH, FUNC).
- Firth penalized logistic regression was used to identify independent predictors of poor functional outcome (modified Rankin Scale 3-6 at 3 months).
Main Results:
- Poor functional outcome was observed in 60.2% of patients; 3-month mortality was 36.8%.
- Independent predictors of poor outcome included lower Glasgow Coma Scale, larger hematoma volume, NCCT hypodensities, hypertension history, and lower LDL cholesterol.
- The developed model demonstrated good discrimination (AUC 0.872) and outperformed ICH and FUNC scores.
Conclusions:
- Neurological severity, hematoma volume, NCCT hypodensities, and specific clinical/laboratory factors independently predict poor 3-month functional outcome in ICH.
- Integrating clinical, volumetric, and CT morphological data improves prognostic discrimination.
- Findings require prospective validation for clinical implementation.
Background/Objectives:
Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and disability. We aimed to identify clinical, laboratory, and imaging factors independently associated with 3-month functional outcome across non-contrast computed tomography (NCCT) morphological markers, laboratory biomarkers, and established clinical scoring systems.
Methods:
This retrospective cohort study included 337 consecutive patients with spontaneous ICH admitted between 2019 and 2022. Admission clinical findings, laboratory parameters, NCCT morphological markers (swirl, blend, black hole, island, hypodensities, and satellite signs), volumetrically segmented hematoma volumes, and prognostic scores (ICH and FUNC scores) were recorded. Poor functional outcome was defined as modified Rankin Scale (mRS) 3-6 at 3 months. Independent predictors were identified using a primary Firth penalized multivariable logistic regression model; discrimination (area under the ROC curve, AUC), calibration, and optimism-corrected performance (1000-resample bootstrap) were assessed, and incremental value over the ICH and FUNC scores was tested with the DeLong method.
Results:
Poor functional outcome occurred in 60.2% of patients, and 3-month mortality was 36.8%. In the primary penalized model, independent predictors of poor outcome were lower admission Glasgow Coma Scale, larger hematoma volume, NCCT hypodensities, history of hypertension, and lower low-density lipoprotein (LDL) cholesterol. The model showed good discrimination (apparent AUC 0.881; optimism-corrected 0.872) and calibration (slope 0.92) and significantly outperformed the ICH and FUNC scores (DeLong p = 0.009 and p < 0.001, respectively). Several laboratory and treatment variables reached significance only in an unpenalized model and were statistically unstable; these were treated as exploratory. Although swirl, blend, black hole, and island signs were associated with poor outcomes in univariable analysis, they did not remain independent predictors in the final model. The ICH and FUNC scores were significantly associated with poor functional outcome in univariable analysis.
Conclusions:
Poor 3-month functional outcome after spontaneous ICH is independently associated with neurological severity, hematoma volume, NCCT hypodensities, and selected clinical and laboratory factors. Integrating clinical, volumetric, and CT morphological parameters improved discrimination over established prognostic scores; however, these findings are associative and require prospective, multicenter validation before clinical implementation.
