Severity assessment in maximally treated ICH patients: The max-ICH score.

Sembill, Jochen A; Gerner, Stefan T; Volbers, Bastian; Bobinger, Tobias; Lücking, Hannes; Kloska, Stephan P; Schwab, Stefan; Huttner, Hagen B; Kuramatsu, Joji B (2017). Severity assessment in maximally treated ICH patients: The max-ICH score. Neurology, 89(5), pp. 423-431. Lippincott Williams & Wilkins 10.1212/WNL.0000000000004174

[img]
Preview
Text
423.full.pdf - Published Version
Available under License Publisher holds Copyright.

Download (675kB) | Preview

OBJECTIVE As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (<24 hours) care limitations (ECL), we investigated its interaction with prognostication in maximally treated patients and sought to provide a new unbiased severity assessment tool. METHODS This observational cohort study analyzed consecutive ICH patients (n = 583) from a prospective registry over 5 years. We characterized the influence of ECL on overall outcome by propensity score matching and on conventional prognostication using receiver operating characteristic analyses. We established the max-ICH score based on independent predictors of 12-month functional outcome in maximally treated patients and compared it to existing models. RESULTS Prevalence of ECL was 19.2% (n = 112/583) and all of these patients died. Yet propensity score matching displayed that 50.7% (n = 35/69) theoretically could have survived, with 18.8% (n = 13/69) possibly reaching favorable outcome (modified Rankin Scale score 0-3). Conventional prognostication seemed to be confounded by ECL, documented by a decreased predictive validity (area under the curve [AUC] 0.67, confidence interval [CI] 0.61-0.73 vs AUC 0.80, CI 0.76-0.83; p < 0.01), overestimating poor outcome (mortality by 44.8%, unfavorable outcome by 10.1%) in maximally treated patients. In these patients, the novel max-ICH score (0-10) integrates strength-adjusted predictors, i.e., NIH Stroke Scale score, age, intraventricular hemorrhage, anticoagulation, and ICH volume (lobar and nonlobar), demonstrating improved predictive accuracy for functional outcome (12 months: AUC 0.81, CI 0.77-0.85; p < 0.01). The max-ICH score may more accurately delineate potentials of aggressive care, showing favorable outcome in 45.4% (n = 214/471) and a long-term mortality rate of only 30.1% (n = 142/471). CONCLUSIONS Care limitations significantly influenced the validity of common prognostication models resulting in overestimation of poor outcome. The max-ICH score demonstrated increased predictive validity with minimized confounding by care limitations, making it a useful tool for severity assessment in ICH patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Volbers, Bastian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

08 Mar 2018 16:21

Last Modified:

22 Oct 2019 18:23

Publisher DOI:

10.1212/WNL.0000000000004174

PubMed ID:

28679602

BORIS DOI:

10.7892/boris.111174

URI:

https://boris.unibe.ch/id/eprint/111174

Actions (login required)

Edit item Edit item
Provide Feedback