脑室内出血严重程度评分：一种新的评分量表，用于评估脑室内出血严重程度，并预测脑出血患者的不良预后。

The slice score: A novel scale measuring intraventricular hemorrhage severity and predicting poor outcome following intracerebral hemorrhage.

机构信息

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China.

出版信息

Clin Neurol Neurosurg. 2020 Aug;195:105898. doi: 10.1016/j.clineuro.2020.105898. Epub 2020 May 11.

DOI:10.1016/j.clineuro.2020.105898

PMID:32497936

Abstract

OBJECTIVES

To quantify extent of intraventricular hemorrhage (IVH) following intracerebral hemorrhage (ICH) with a novel, simple IVH severity score, and to explore and compare its performance in predicting worse outcomes.

PATIENTS AND METHODS

A new scoring system for IVH severity was proposed and termed Slice score. The Slice score features non-septum pellucidum section, internal capsule section, third ventricle occipital horn section, three standardized scans for scoring the lateral ventricles. 652 scans from 326 subjects were retrospectively analyzed. The correlations between measured IVH volume and Slice score, original Graeb, LeRoux, and IVH score (IVHS) were compared. The association between these scores and clinical outcomes were evaluated using logistic regression. We then identified clinical thresholds of Slice score by balancing the probability of prediction and accuracy. Primary outcome was defined as 90-day poor outcome (modiﬁed Rankin Scale score ≥ 4) and secondary outcome was 90-day mortality.

RESULTS

Of 326 ICH patients, 122 (37.4%) had poor outcome and 59 (18.1%) died at 3 months. The Slice score showed the highest correlation with measured IVH volume (R = 0.73, R = 0.54, p < 0.001). The observed area under the curve were similar among the Slice, original Graeb, LeRoux score, and IVH score for poor outcome (0.633, 0.633, 0.632, 0.634, respectively), and for mortality (0.660, 0.660, 0.660, 0.656, respectively). All IVH scales were independently associated with 90-day poor outcome and mortality with close odds ratio in adjusted models (all odds ratio > 1.07, all p < 0.05). Multivariable Analyses of categorized Slice score revealed optimal thresholds of 6 and 12 for primary and secondary outcomes (odds ratio 4.20, 95% confidence interval 1.82-10.02, p = 0.001; odds ratio 5.41, 95% confidence interval 1.66-17.43, p = 0.005, respectively).

CONCLUSIONS

The Slice score correlated highly with the IVH volume, was a reliable volumetric scale for measuring IVH severity, and could be an easy-to-use tool for predicting 90-day poor outcome and mortality in ICH.

摘要

目的

利用一种新的简单颅内出血（ICH）严重程度评分系统，量化脑出血（ICH）后脑室内出血（IVH）的程度，并探讨和比较其在预测预后不良方面的性能。

方法

提出了一种新的 IVH 严重程度评分系统，称为 Slice 评分。Slice 评分的特点是非透明隔切片、内囊切片、第三脑室枕角切片、三个用于评分侧脑室的标准化切片。对 326 例患者的 652 例切片进行回顾性分析。比较了测量的 IVH 体积与 Slice 评分、原始 Graeb 评分、LeRoux 评分和 IVH 评分（IVHS）之间的相关性。使用逻辑回归评估这些评分与临床结果的关系。然后通过平衡预测概率和准确性来确定 Slice 评分的临床阈值。主要结局定义为 90 天预后不良（改良 Rankin 量表评分≥4），次要结局为 90 天死亡率。

结果

在 326 例 ICH 患者中，122 例（37.4%）预后不良，59 例（18.1%）在 3 个月时死亡。Slice 评分与测量的 IVH 体积相关性最高（R=0.73，R=0.54，p<0.001）。Slice、原始 Graeb、LeRoux 评分和 IVH 评分对预后不良的观察曲线下面积相似（分别为 0.633、0.633、0.632、0.634），对死亡率的观察曲线下面积也相似（分别为 0.660、0.660、0.660、0.656）。所有 IVH 评分在调整模型中均与 90 天预后不良和死亡率独立相关，比值比接近（所有比值比均大于 1.07，均 p<0.05）。对分类 Slice 评分的多变量分析显示，原发性和继发性结局的最佳阈值分别为 6 和 12（比值比 4.20，95%置信区间 1.82-10.02，p=0.001；比值比 5.41，95%置信区间 1.66-17.43，p=0.005）。