最佳基线临床严重程度评分截断点预测脑出血预后：INTERACT 研究。

Optimum Baseline Clinical Severity Scale Cut Points for Prognosticating Intracerebral Hemorrhage: INTERACT Studies.

机构信息

Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S. You, Y.C., C.-F.L.).

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.).

出版信息

Stroke. 2024 Jan;55(1):139-145. doi: 10.1161/STROKEAHA.123.044538. Epub 2023 Nov 29.

DOI:10.1161/STROKEAHA.123.044538

PMID:38018833

Abstract

BACKGROUND

The optimal cut point of baseline National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale scores for prognosticating acute intracerebral hemorrhage (ICH) is unknown.

METHODS

Secondary analyses of participant data are from the INTERACT (Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trials) 1 and 2 studies. Receiver operating characteristic analyses were used to compare the predictive performance of baseline NIHSS and Glasgow Coma Scale scores, ICH score, and max-ICH score. Optimal cut points for predicting 90-day clinical outcomes (death or major disability [defined as modified Rankin Scale scores 3-6], major disability [defined as modified Rankin Scale scores 3-5], and death alone) were determined using the Youden index. Logistic regression models were adjusted for age, sex, hematoma volume, and other known risk factors for poor prognosis. We validated our findings in the INTERACT1 database.

RESULTS

There were 2829 INTERACT2 patients (age, 63.5±12.9 years; male, 62.9%; ICH volume, 10.96 [5.77-19.49] mL) included in the main analyses. The baseline NIHSS score (area under the curve, 0.796) had better prognostic utility for predicting death or major disability than the Glasgow Coma Scale score (area under the curve, 0.650) and ICH score (area under the curve, 0.674) and was comparable to max-ICH score (area under the curve, 0.789). Similar findings were observed when assessing the outcome of major disability. A cut point of 10 on baseline NIHSS optimally (sensitivity, 77.5%; specificity, 69.2%) predicted death or major disability (adjusted odds ratio, 4.50 [95% CI, 3.60-5.63]). The baseline NIHSS cut points that optimally predicted major disability and death alone were 10 and 12, respectively. The predictive effect of NIHSS≥10 for poor functional outcomes was consistent in all subgroups including age and baseline hematoma volume. Results were consistent when analyzed in the independent INTERACT1 validation database.

CONCLUSIONS

In patients with mild-to-moderate ICH, a baseline NIHSS score of ≥10 was optimal for predicting poor outcomes at 90 days. Prediction based on baseline NIHSS is better than baseline Glasgow Coma Scale score.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00226096 and NCT00716079.

摘要

背景

目前尚不清楚预测急性脑出血（ICH）的最佳基线国立卫生研究院卒中量表（NIHSS）和格拉斯哥昏迷量表评分切点。

方法

对 INTERACT（急性脑出血强化降压试验）1 期和 2 期研究参与者数据的二次分析。使用受试者工作特征分析比较基线 NIHSS 和格拉斯哥昏迷量表评分、ICH 评分和最大 ICH 评分的预测性能。使用约登指数确定预测 90 天临床结局（死亡或主要残疾[定义为改良 Rankin 量表评分 3-6]、主要残疾[定义为改良 Rankin 量表评分 3-5]和单独死亡）的最佳截断点。使用逻辑回归模型对年龄、性别、血肿体积和其他预后不良的已知危险因素进行调整。我们在 INTERACT1 数据库中验证了我们的发现。

结果

纳入了 2829 例 INTERACT2 患者（年龄 63.5±12.9 岁；男性 62.9%；ICH 体积 10.96[5.77-19.49]mL）。基线 NIHSS 评分（曲线下面积，0.796）在预测死亡或主要残疾方面优于格拉斯哥昏迷量表评分（曲线下面积，0.650）和 ICH 评分（曲线下面积，0.674），与最大 ICH 评分（曲线下面积，0.789）相当。在评估主要残疾的结果时也观察到类似的发现。基线 NIHSS 评分 10 分是最佳截断点（敏感性，77.5%；特异性，69.2%），可预测死亡或主要残疾（调整比值比，4.50[95%CI，3.60-5.63]）。最佳预测主要残疾和单独死亡的 NIHSS 基线截断点分别为 10 和 12。NIHSS≥10 对不良功能结局的预测效果在包括年龄和基线血肿体积在内的所有亚组中均一致。在独立的 INTERACT1 验证数据库中进行分析时，结果一致。