Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Int J Stroke. 2020 Jan;15(1):90-102. doi: 10.1177/1747493019830589. Epub 2019 Feb 12.
Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction.
Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0-2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses.
The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence ( = 0.008) and mortality ( = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3-9 = 2 points; 10-13 = 1 point), volume-location (lobar:≥24 mL=2 points, 21-24 mL=1 point; deep:≥8 mL=2 points, 7-8 mL=1 point; brainstem:≥6 mL=2 points, 3-6 mL=1 point; cerebellum:≥24 mL=2 points, 12-24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, = 0.002) but not mortality (0.838 vs. 0.841, = 0.918) discrimination compared to the original ICH score.
The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume-location relationship plays an important role in ICH outcome prediction.
自发性脑出血（ICH）后的功能预后可能取决于血肿量和血肿位置。我们评估了血肿量和位置之间的相互作用，并对原始 ICH 评分进行了修改，以纳入这种相互作用。
连续ICH 患者于 2009 年至 2017 年纳入颅内出血结果项目。纳入标准为年龄≥18 岁、基线改良 Rankin 量表（mRS）评分 0-2、神经影像学和随访。功能依赖性和死亡率定义为 90 天 mRS>2 和死亡。采用多变量回归和接收者操作特征曲线（AUROC）分析方法制定了位置 ICH 评分。
研究队列包括 311 例患者，推导队列和验证队列分别包括 209 例和 102 例患者。血肿量和位置之间的相互作用预测了功能依赖性（=0.008）和死亡率（=0.025）。位置 ICH 评分包括年龄≥80 岁（1 分）、格拉斯哥昏迷量表评分（3-9=2 分；10-13=1 分）、体积-位置（皮质下：≥24ml=2 分，21-24ml=1 分；深部：≥8ml=2 分，7-8ml=1 分；脑干：≥6ml=2 分，3-6ml=1 分；小脑：≥24ml=2 分，12-24ml=1 分）和脑室内出血（1 分）。位置 ICH 评分对功能依赖性的 AUROC 高于原始 ICH 评分（0.883 比 0.770，=0.002），但对死亡率的 AUROC 没有差异（0.838 比 0.841，=0.918）。
血肿量和位置之间的相互作用对结局有独立影响。通过将特定位置的体积阈值纳入预测模型，对功能依赖性和死亡率的区分度极好。因此，血肿位置关系在 ICH 预后预测中起着重要作用。
