scholarly journals A Delayed Modified ICH Score Outperforms Baseline Scoring in Acute Intracerebral Hemorrhage

2019 ◽  
Vol 10 (3) ◽  
pp. 217-220
Author(s):  
Ronda Lun ◽  
Vignan Yogendrakumar ◽  
Dylan Blacquiere ◽  
Michel Shamy ◽  
Grant Stotts ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Patient Characteristics ◽  
Prognostic Scores ◽  
Secondary Outcome ◽  
Predictive Values ◽  
Poor Outcome ◽  
Acute Intracerebral Hemorrhage

The Modified Intracerebral Hemorrhage (MICH) score is a simple tool created to provide prognostication in basal ganglia hemorrhages. Current prognostic scores, including the MICH, are based on the assessment of baseline patient characteristics, failing to account for significant developments, such as intraventricular extension and clinical deterioration, which may occur over the first 72 hours. We propose to validate the MICH in all hemorrhage locations and hypothesize that its calculation at 72 hours will outperform its baseline counterpart with respect to predicting mortality and functional outcome. We performed a retrospective analysis of collated data from the Virtual International Stroke Trials Archive database. Primary outcome was 90-day mortality. Secondary outcome was poor outcome (modified Rankin Scale 4-6) at 90 days. Receiver operating characteristic curves were generated looking at the predictive ability of the MICH score for mortality and poor outcome, at baseline and at 72 hours. Competing curves were assessed with nonparametric methods. A total of 226 patients were included, with a 90-day mortality of 22.5%. The MICH scores calculated at 72 hours were more predictive of mortality than at baseline (area under the curve [AUC]: 0.89 [95% confidence interval [CI]: 0.83-0.94] vs 0.78 [95% CI: 0.70-0.85]), P < .01. The MICH scores at 72 hours similarly better predicted functional outcome (AUC: 0.78 [95% CI: 0.72-0.84] vs AUC: 0.72 [95% CI: 0.66-0.78]), P = .047. The MICH score has positive prognostic value for mortality and poor functional outcome in all hemorrhage locations. Delaying its calculation resulted in higher predictive values for both and suggests that delaying discussions around withdrawal of care may result in more accurate prognostication in acute intracerebral hemorrhage.

Abstract 32: Optimal Threshold for Defining Early Clinical Deterioration as a Predictor of Poor Outcome in Acute Intracerebral Hemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
David S Liebeskind ◽  
Adrian M Burgos ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Final Outcome ◽  
Clinical Deterioration ◽  
Coma Scale ◽  
Poor Outcome ◽  
Scale Scores ◽  
Acute Intracerebral Hemorrhage ◽  
Gcs Score

Background: Many patients with acute intracerebral hemorrhage (ICH) clinically deteriorate between the time of paramedic assessment in the field and Emergency Department (ED) arrival. Cohort studies have used decline in the Glasgow Coma Scale (GCS) score from prehospital assessment to ED assessment to identify patients with early clinical deterioration (ECD), but the degree of GCS decline that best correlates with poor final functional outcome has not been delineated. Methods: Consecutive cases with primary ICH on initial imaging were identified from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial of intravenous magnesium vs. placebo. All subjects underwent GCS evaluation in the field by paramedics within 2 hours from symptom onset, and again in the ED by study research coordinators. Poor outcome was defined as a modified Rankin Scale of 4 to 6 at 3-months. Deteriorations in GCS from one point through 10 points were evaluated in relation to poor final functional outcome through receiver operating characteristic (ROC) and area under curve (AUC). Results: Among the 369 (22%) patients with primary ICH, mean [SD] age was 65 [13] years, 34% were women, 79% White race, 34% Hispanic ethnicity, 80% had pre-existing hypertension, 20% diabetes, 18% smokers. Paramedic on scene time was a median [IQR] of 23 [15-40] minutes from last known well and time of GCS assessment in the ED was a median of 140 [119-175] minutes after last known well. Glasgow Coma Scale scores were mean 14.4 (SD 1.5) and median 15 [15-15] in the field and mean 12.1 (SD 4.5) and median 15 [10-15] in the ED, and 59% had a poor outcome at 3 months. Frequency of deteriorations on the GCS included: ≥1 point - 38%, ≥2points - 31%, ≥3 points - 27%, ≥5 points - 21%, and ≥10 points - 13%. The best performing cutpoints on the the ROC for predicting poor final outcome were ECD definitions of GCS decline of >=1: sensitivity 54% and specificity 85%; and GCS decline of >=2: sensitivity 46% and specificity 91%. The c statistic for ECD defined as a 1 point GCS decline as a predictor of poor final outcome was 0.71 (95%CI 0.66, 0.76). Conclusions: Early clinical deterioration of GCS is common and its presence may be helpful in predicting poor outcome.

scholarly journals Calculation of Prognostic Scores, Using Delayed Imaging, Outperforms Baseline Assessments in Acute Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1107-1110 ◽  
Author(s):  
Ronda Lun ◽  
Vignan Yogendrakumar ◽  
Andrew M. Demchuk ◽  
Richard I. Aviv ◽  
David Rodriguez-Luna ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Prognostic Scores ◽  
Hematoma Expansion ◽  
Imaging Data ◽  
Spot Sign ◽  
Delayed Imaging ◽  
Predictive Values ◽  
Ich Score

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.

Hydrocephalus Growth: Definition, Prevalence, Association with Poor Outcome in Acute Intracerebral Hemorrhage

2020 ◽  
Author(s):  
Wen-Song Yang ◽  
Yi-Qing Shen ◽  
Xiao-Dong Zhang ◽  
Li-Bo Zhao ◽  
Xiao Wei ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Poor Outcome ◽  
Acute Intracerebral Hemorrhage

scholarly journals Decreased Time to Evacuation Improves Long Term Functional Outcome in Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Christopher P Kellner ◽  
Rui Song ◽  
Dominic A Nistal ◽  
Ian T McNeill ◽  
Hasitha M Samarage ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
National Institutes Of Health ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clinical Criteria ◽  
Poor Outcome ◽  
Deep Location

Abstract INTRODUCTION Preclinical and preliminary clinical data suggests that early minimally invasive intracerebral hemorrhage evacuation may convey a functional outcome benefit. Ongoing clinical trials permit an operative window extending out to 72 h. Here we present long term functional outcome after MIS endoscopic ICH evacuation with a focus on time to evacuation. METHODS Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit previously published clinical criteria including age = 18, National Institutes of Health Stroke Scale (NIHSS) = 6, hematoma volume = 15, and baseline modified Rankin Score (mRS) = 3 with a CTA negative for vascular malformation. Retrospective review was performed on patients who were treated in a single health system from December 2015 to August 2018. Demographic, clinical and radiographic previously demonstrated to impact ICH outcome were included in a multivariate logistic regression to identify factors predicting poor outcome (modified Rankin scale (mRS) 4-6) at 6 mo. RESULTS A total of 97 patients underwent minimally invasive endoscopic ICH evacuation. In a multivariate analysis, factors that predicted poor outcome included age (OR 1.81 (CI 1.15-3.08) P = .016), deep location (OR 11.1 (2.41-67.8) P = .004), presence of intraventricular hemorrhage (OR 5.81 (1.765-22.39) P = .006) and increased time to evacuation measured in hours (OR 1.048 (CI 1.017-1.084) P = .004). CONCLUSION Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every minute counts.

Obesity is associated with better survival and functional outcome after acute intracerebral hemorrhage

2016 ◽  
Vol 370 ◽  
pp. 140-144 ◽  
Author(s):  
Weiping Sun ◽  
Ying Xian ◽  
Yining Huang ◽  
Wei Sun ◽  
Ran Liu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Acute Intracerebral Hemorrhage

scholarly journals Associations and prognostic accuracy of electrolyte imbalances in predicting poor COVID-19 outcome: a systematic review and meta-analysis of 28 observational studies

2021 ◽  
Author(s):  
Harris Jun Jie Muhammad Danial Song ◽  
Alys Zhi Qin Chia ◽  
Benjamin Kye Jyn Tan ◽  
Chong Boon Teo ◽  
Horng Ruey Chua ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Observational Studies ◽  
Inflammatory Marker ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Cochrane Library ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Poor Outcome ◽  
Prognostic Accuracy

BACKGROUND: Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. OBJECTIVES: To systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome. METHODS: PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR+, LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed. RESULTS: We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR=2.08, 95%CI=1.48-2.94, I2=93%, N=8), hypernatremia (OR=4.32, 95%CI=3.17-5.88, I2=45%, N=7) and hypocalcemia (OR=3.31, 95%CI=2.24-4.88, I2=25%, N=6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR+ 4.0, PPV=55%, AUC=0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV=87%, AUC=0.71). Overall quality of evidence ranged from very low to moderate. CONCLUSION: Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.

Prognostic Significance of Serum Magnesium in Acute Intracerebral Hemorrhage Patients

2019 ◽  
Vol 16 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Xianjun Han ◽  
Shoujiang You ◽  
Zhichao Huang ◽  
Qiao Han ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Serum Magnesium ◽  
Prognostic Significance ◽  
Stroke Severity ◽  
Linear Regression Models ◽  
Poor Functional Outcome ◽  
All Cause Mortality ◽  
Acute Intracerebral Hemorrhage

Background: Experimental animal model studies have shown neuroprotective properties of magnesium. We assessed the relationship between admission magnesium and admission stroke severity and 3-month clinical outcomes in patients with acute intracerebral hemorrhage (ICH). Methods: The present study included 323 patients with acute ICH who were prospectively identified. Demographic characteristics, lifestyle risk factors, National Institute of Health Stroke Scale (NIHSS) score, hematoma volumes, and other clinical features were recorded at baseline for all participants. Patients were divided into three groups based on the admission magnesium levels (T1: <0.84; T2: 0.84-0.91; T3: =0.91 mmol/L). Clinical outcomes were death, poor functional outcome (defined by modified rankin ccale [mRS] scores 3-6) at 3 months. Results: After 3-month follow-up, 40 (12.4%) all-cause mortality and 132 (40.9%) poor functional outcome were documented. Median NIHSS scores for each tertile (T1 to T3) were 8.0, 5.5, and 6.0, and median hematoma volumes were 10.0, 8.05, and 12.4 ml, respectively. There was no significant association between baseline NIHSS scores (P=0.176) and hematoma volumes (P=0.442) in T3 and T1 in multivariable linear regression models. Compared with the patients in T1, those in T3 were associated with less frequency of all-cause mortality [adjusted odds ratio (OR), 0.10; 95% confidence interval (CI), 0.02-0.54; P-trend=0.010] but not poor functional outcome (adjusted OR, 1.80; 95%CI, 0.71-4.56; P-trend=0.227) after adjustment for potential confounders. Conclusion: Elevated admission serum magnesium level is associated with lower odds of mortality but not poor functional outcome at 3 months in patients with acute ICH.

Abstract W P259: ICH &FUNC Scores in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kevin N Sheth ◽  
Gene Sung ◽  
Carl D Langefeld ◽  
Charles J Moomaw ◽  
Jennifer Osborne ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Rank Correlation ◽  
Predictive Ability ◽  
Spearman’S Rank Correlation ◽  
Hispanic Patients ◽  
Chart Abstraction ◽  
Ich Score ◽  
Hispanic White

Introduction: The Intracerebral Hemorrhage (ICH) Score and Functional Outcome (FUNC) Score are prediction scales used to estimate outcome. These scales have not yet been validated in large minority cohorts. Our goal was to evaluate the predictive ability of the ICH and FUNC Score for white, black, and Hispanic patients. Methods: ERICH is an ongoing study of genetic and environmental risk factors for spontaneous ICH. The analysis included 847 cases enrolled prior to 1/1/2013 that had chart abstraction, baseline interview, CT imaging, GCS, and 3-month follow-up data available. Spearman’s rank correlation was used to assess the correlation between each score and 3-month modified Rankin Scale (mRS) score by ethnicity. Regression models were used to determine the predictive ability of each score. Results: Patients analyzed were 42% non-Hispanic black, 34% Hispanic, and 24% non-Hispanic white. Black and Hispanic subjects were younger compared with white subjects (p<.0001) and had higher proportions of deep ICH (p=.0013). Spearman’s rank correlations for ICH Score/FUNC Score and mRS at 3 months post ICH were 0.53/0.53 for black subjects, 0.66/0.63 for Hispanics, and 0.55/0.54 for whites. Both ICH and FUNC Scores had better predictive ability for minorities compared with whites (ICH Score, B = 0.87 black, 1.02 Hispanic, 0.76 white, p<.0001; FUNC Score, B = 0.56 black, 0.65 Hispanic, 0.49 white, p<.0001). Multiple regression demonstrated independent contributions by both scores for each ethnicity. Figure 1 demonstrates distribution of mortality by score. Conclusions: Both the ICH Score and FUNC Score were independently predictive of functional outcome at 3 months. Importantly, each score exhibits higher predictive ability in minority populations compared with whites. Whether or not this difference is attributed to minority status or baseline differences in age or ICH location requires further study.

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