Rodríguez-Fernández Sonia, Castillo-Lorente Encarnación, Guerrero-Lopez Francisco, Rodríguez-Rubio David, Aguilar-Alonso Eduardo, Lafuente-Baraza Jesús, Gómez-Jiménez Francisco Javier, Mora-Ordóñez Juan, Rivera-López Ricardo, Arias-Verdú María Dolores, Quesada-García Guillermo, Arráez-Sánchez Miguel Ángel, Rivera-Fernández Ricardo
Intensive Care Medicine, Hospital de la Serranía, Ronda, Spain.
Programa de Doctorado, Universidad de Granada, Granada, Spain.
BMJ Open. 2018 Aug 13;8(8):e021719. doi: 10.1136/bmjopen-2018-021719.
Validation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU).
A multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated.
A total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50-70) years.
APACHE-II: 21(15-26) points, GCS: 7 (4-11) points, ICH score: 2 (2-3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79).
ICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.
对入住重症监护病房（ICU）的自发性脑出血（ICH）患者的脑出血评分进行验证。
在2009年至2012年期间，对西班牙安达卢西亚地区三家设有神经外科的医院ICU收治的所有连续性ICH患者进行了一项多中心队列研究。收集的数据包括ICH、格拉斯哥昏迷量表（GCS）和急性生理与慢性健康状况评估II（APACHE-II）评分。还整理了人口统计学数据、血肿位置和体积以及30天死亡率。
共纳入336例患者，其中105例接受了手术。中位（四分位间距）年龄：62（50 - 70）岁。
APACHE-II：21（15 - 26）分，GCS：7（4 - 11）分，ICH评分：2（2 - 3）分。11.1%的患者入院时出现双侧瞳孔散大（死亡率 = 100%）。58.9%的患者观察到脑室内出血。院内死亡率为54.17%，而APACHE-II预测死亡率为57.22%，标准化死亡率比（SMR）为0.95（95%可信区间0.81至1.09），Hosmer-Lemenshow检验值（H）为3.62（无显著统计学差异，n.s.）。30天死亡率为52.38%，而ICH评分预测死亡率为48.79%，SMR：1.07（95%可信区间0.91至1.23），n.s.。在最低评分时死亡率高于预测值，在病情较重的患者中低于预测值，（H = 55.89，p < 0.001），意大利重症治疗评估组校准带（p < 0.001）。受试者工作特征（ROC）曲线下面积为0.74（95%可信区间0.69至0.79）。
ICH评分作为预测入住ICU的自发性ICH患者死亡率的工具，显示出可接受的区分度，但其校准并不理想。
