Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis
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Intracerebral hemorrhage (ICH) is a devastating disorder, responsible for 10% of all strokes. Several prognostic scores have been developed for this population to predict mortality and functional outcome. The aim of this study was to determine the four most frequently validated and most widely used scores, assess their discrimination for both outcomes by means of a systematic review with meta-analysis, and compare them using meta-regression.
PubMed, ISI Web of Knowledge, Scopus, and CENTRAL were searched for studies validating the ICH score, ICH-GS, modified ICH, and the FUNC score in ICH patients. C-statistic was chosen as the measure of discrimination. For each score and outcome, C-statistics were aggregated at four different time points using random effect models, and heterogeneity was evaluated using the I2 statistic. Score comparison was undertaken by pooling all C-statistics at different time points using robust variance estimation (RVE) and performing meta-regression, with the score used as the independent variable.
Fifty-three studies were found validating the original ICH score, 14 studies were found validating the ICH-GS, eight studies were found validating the FUNC score, and five studies were found validating the modified ICH score. Most studies attempted outcome prediction at 3 months or earlier. Pooled C-statistics ranged from 0.76 for FUNC functional outcome prediction at discharge to 0.85 for ICH-GS mortality prediction at 3 months, but heterogeneity was high across studies. RVE showed the ICH score retained the highest discrimination for mortality (c = 0.84), whereas the modified ICH score retained the highest discrimination for functional outcome (c = 0.80), but these differences were not statistically significant.
The ICH score is the most extensively validated score in ICH patients and, in the absence of superior prediction by other scores, should preferably be used. Further studies are needed to validate prognostic scores at longer follow-ups and assess the reasons for heterogeneity in discrimination.
KeywordsCerebral hemorrhage Prognosis Decision support techniques Mortality Morbidity
The authors wish to thank Dr Laura Stapleton for proofreading the final manuscript for clarity and conciseness.
TG conceived and designed the project, acquired, analyzed and interpreted the data, and wrote the manuscript; SP, PC, GA, and IA acquired data; PCC analyzed and interpreted data; LA designed the project, analyzed, and interpreted data; all authors critically reviewed and approved the final version of the manuscript.
Source of Support
There were no sources of funding for the current study.
Compliance with Ethical Standards
Conflicts of interest
The authors declare they have no conflicts of interest.
- 1.Van Asch CJJ, Luitse MJA, Rinkel GJE, Van Der Tweel I, Algra A, Klijn CJM. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin : a systematic review and meta-analysis. Lancet Neurol. 2017;9(2):167–76.Google Scholar
- 3.Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. 2015.Google Scholar
- 8.Zhou X, Obuchowski N. Statistical methods in diagnostic medicine. New York: Blackwell Publishing, Inc.; 2002.Google Scholar
- 15.Chuang YC, Chen YM, Peng SK, Peng SY. Risk stratification for predicting 30-day mortality of intracerebral hemorrhage. Int J Qual Heal Care. 2009;21(6):441–7.Google Scholar
- 17.Creutzfeld CJ, Becker KJ, Weinstein JR, et al. Do-not-attempt-resuscitation orders and prognostic models for intraparenchymal hemorrhagelic access. Crit Care Med. 2011;39(1):158–62.Google Scholar
- 20.Faigle R, Marsh EB, Llinas RH, Urrutia VC, Gottesman RF. Race-specific predictors of mortality in intracerebral hemorrhage: differential impacts of intraventricular hemorrhage and age among Blacks and Whites. J Am Heart Assoc. 2016;5(8):1–8.Google Scholar
- 22.Ghelmez D, Tuta S, Popa C, Diseases N. Prognostic factors in hypertensive. Rom J Neurol. 2013;12(4):202–5.Google Scholar
- 31.Ji R, Shen H, Pan Y, et al. A novel risk score to predict 1-year functional outcome after intracerebral hemorrhage and comparison with existing scores. Crit Care. 2013;17(1466–609X (Electronic)):275.Google Scholar
- 37.Muengtaweepongsa S, Seamhan B. Predicting mortality rate with ICH score in Thai intracerebral hemorrhage patients. Neurol Asia. 2013;18(2):131–5.Google Scholar
- 44.Romano LM, Ioli PL, Gonorazky SE, et al. Desarollo y validación de la escala predictiva de mortalidad (REC-HPC) en la hemorragia intracerebral primaria. Neurol Argentina. 2009;1(2):75–81.Google Scholar
- 49.Stein M, Luecke M, Preuss M, Scharbrodt W, Joedicke A, Oertel MF. The prediction of 30-day mortality and functional outcome in spontaneous intracerebral hemorrhage with secondary ventricular hemorrhage: a score comparison. Acta Neurochir (Wien). 2011;112:10–2.Google Scholar
- 70.Barret RJ, Hussain R, Coplin WM, et al. Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage. Neurocrit Care. 2005;3(1):237–45.Google Scholar
- 72.Cerillo A, Vizioli L, Falivene R, Mottolese C, Bernini FP, Tedeschi G. Intracerebral hemorrhage: an attempt of statistical assessment for operability. Acta Neurol (Napoli). 1981;3(4):572–86.Google Scholar
- 75.Romano LM, Ioli P, Gonorazky S. Variables predictivas de letalidad y validacíon externa de la escala original de hemorragia intracerebral espontánea. Rev Neurol Argentina. 2007;32:94–9.Google Scholar
- 80.Zorilla JP, Sousa L, Ioli P, et al. Variables predictivas de letalidad y rendimiento de la escala ReC-HPC en hemorragia intracerebral primaria en pacientes anticoagulados. Neurol Argentina. 2011;3(2):94–9.Google Scholar