From the Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa, Canada (R.L., V.Y., D.D.).
Calgary Stroke Program, Department of Clinical Neurosciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, University of Calgary, Canada.
Stroke. 2020 Apr;51(4):1107-1110. doi: 10.1161/STROKEAHA.119.027119. Epub 2020 Mar 10.
Background and Purpose- Patients with intracerebral hemorrhage (ICH) are often subject to rapid deterioration due to hematoma expansion. Current prognostic scores are largely based on the assessment of baseline radiographic characteristics and do not account for subsequent changes. We propose that calculation of prognostic scores using delayed imaging will have better predictive values for long-term mortality compared with baseline assessments. Methods- We analyzed prospectively collected data from the multicenter PREDICT study (Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign). We calculated the ICH Score, Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score, and modified ICH Score using imaging data at initial presentation and at 24 hours. The primary outcome was mortality at 90 days. We generated receiver operating characteristic curves for all 3 scores, both at baseline and at 24 hours, and assessed predictive accuracy for 90-day mortality with their respective area under the curve. Competing curves were assessed with nonparametric methods. Results- The analysis included 280 patients, with a 90-day mortality rate of 25.4%. All 3 prognostic scores calculated using 24-hour imaging were more predictive of mortality as compared with baseline: the area under the curve was 0.82 at 24 hours (95% CI, 0.76-0.87) compared with 0.78 at baseline (95% CI, 0.72-0.84) for ICH Score, 0.84 at 24 hours (95% CI, 0.79-0.89) compared with 0.76 at baseline (95% CI, 0.70-0.83) for FUNC, and 0.82 at 24 hours (95% CI, 0.76-0.88) compared with 0.74 at baseline (95% CI, 0.67-0.81) for modified ICH Score. Conclusions- Calculation of the ICH Score, FUNC Score, and modified ICH Score using 24-hour imaging demonstrated better prognostic value in predicting 90-day mortality compared with those calculated at presentation.
背景与目的-颅内出血（ICH）患者常因血肿扩大而迅速恶化。目前的预后评分主要基于基线影像学特征的评估，而不考虑后续变化。我们提出，使用延迟成像计算预后评分，与基线评估相比，对长期死亡率具有更好的预测价值。
方法-我们分析了多中心 PREDICT 研究（使用 CT 血管造影点征预测颅内出血患者的血肿增长和预后）前瞻性收集的数据。我们使用初始和 24 小时的影像学数据计算 ICH 评分、原发性颅内出血患者功能结局（FUNC）评分和改良 ICH 评分。主要结局为 90 天死亡率。我们生成了所有 3 种评分的受试者工作特征曲线，包括基线和 24 小时，并使用各自的曲线下面积评估了对 90 天死亡率的预测准确性。使用非参数方法评估竞争曲线。
结果-分析纳入了 280 例患者，90 天死亡率为 25.4%。使用 24 小时影像学计算的所有 3 种预后评分对死亡率的预测均优于基线：24 小时的曲线下面积为 0.82（95%CI，0.76-0.87），而基线为 0.78（95%CI，0.72-0.84）；ICH 评分 0.84（95%CI，0.79-0.89），而基线为 0.76（95%CI，0.70-0.83）；FUNC 评分 0.82（95%CI，0.76-0.88），而基线为 0.74（95%CI，0.67-0.81）；改良 ICH 评分。
结论-使用 24 小时影像学计算 ICH 评分、FUNC 评分和改良 ICH 评分在预测 90 天死亡率方面比在初始评估时具有更好的预后价值。
