Prediction of 30-days Mortality of Intracerebral Hemorrhage by a Powerful but Easy to Use Intracerebral Hemorrhage Score
Ahmed Esmael
Department of Neurology, Faculty of Medicine, Mansoura University, Egypt
Mohammed El Sherif *
Department of Neurology, Faculty of Medicine, Mansoura University, Egypt
Mohamed Saad
Department of Neurology, Faculty of Medicine, Mansoura University, Egypt
*Author to whom correspondence should be addressed.
Abstract
Background: Spontaneous Intracerebral Hemorrhage (sICH) is one of the main reasons of morbidity and mortality globally. Many anticipating scales developed for sICH to be used in systematic clinical approach.
Objectives: To predict the mortality in cases of sICH meanwhile the first month by early assessment details applying a simplified ICH score.
Patients and Methods: This is a prospective study conducted on patients with sICH who admitted at convalescence and critical cases building in Mansoura University Hospitals (CCCB-MUH) during one year. Demographics of the patients, mortality as well as the clinic and radiologic findings of ICH were collected. The clinical scales {National institutes of Health Stroke Scale (NIHSS) scoring, Glasgow Coma Scale (GCS), and intracerebral hemorrhage score (ICHS)} were evaluated for all the patients at admission. Modified Rankin Scale (mRS) was evaluated after 30 days.
Results: A total of 360 patients with sICH was studied, with a mean age of 62±14 years with males 55.8%. Through 30 days' fatality was 15% (n=54). Elderliness groups especially age ≥80 years were combined with the high statistically significant mortality rate (P < 0.00001). The most common risk factor for sICH was hypertension, smoking, diabetes mellitus, coagulation disorders, cardiac, hyperlipidemia, and history of previous stroke (72%, 34%, 19%, 15, 14%, 14% and 12% respectively). However, there was no statistical difference between survived and died cases in 30 days regarding risk factors in both groups. The radiological characters of cases showing significant very high mortality with larger hematoma volume ≥30 cm (P value =0.0001), followed by the infratentorial location of hematoma (P value =0.0007), then intraventricular hemorrhage (P value =0.0122). While midline shift and hydrocephalus were not associated with significantly high mortality (P= 0.076 & P= 0.125 respectively). Lower GCS was the most statistically significantly clinical scale correlated with high mortality (P < 0.00001), followed by mRS (P= 0.0002). While, NIHSS was less significantly correlated with high mortality (P < 0.0005). The variables that construct the sICH score were chosen from logistic regression, showing that GCS score was the most strongly correlated with thirty days' mortality (P < 0.001), then the age ≥80 years (P < 0.005) followed by the volume of ICH (P < 0.005), then the location of ICH (P < 0.007), and lastly the presence of intraventricular extension of blood (P < 0.05). All patients with the score of 5 and 6 were died in first thirty days, whereas no patient died in first thirty days with a score of 0. While, first thirty-day mortality for patients with scores of 4, 3, 2, and 1 were 77.7%, 63.6%, 19.6%, and 9.6% respectively. The ICH Score was specific by 91.5% with a high negative predictive value for mortality by 94.1% and was sensitive by 93.4% with a high negative predictive value for good outcome by 92.7%.
Conclusion: The ICHS is a valid clinical grading scale for 30 days' functional outcome after sICH.
Keywords: National institutes of health stroke scale, modified rankin scale, glasgow coma scale, intracerebral hemorrhage score