The accuracy of ICH-FOS for spontaneous intracerebral hemorrhage: An analysis of ATACH-2 and the Qatar stroke database

Abstract

Introduction: Spontaneous intracranial hemorrhage(sICH) comprise between 15-20% of stroke with high rates of mortality and disability. Multiple scoring systems have been developed for sICH prognostication.

Aims: We explored the Qatar stroke database and the ATACH-2 database to study the independent predictors of 90-day mortality and poor functional outcomes[modified rankin score(mRS) 4-6] in patients with sICH. We compared admission national institute of health stroke scale (NIHSS) and Glasgow coma scale (GCS) with original intracerebral hemorrage(o-ICH), modified(m)ICH, ICH-GS(grading scale), Lanseed(LS)-ICH, Max-ICH, and ICH-FOS(functional outcome score) scores to evaluate 90-day mortality and functional outcomes.

Methods: Data on baseline characteristics, premorbid condition, laboratory tests, imaging findings, and surgical treatment were included. Outcomes were mortality and poor functional outcome(mRS 4-6) at 90-day follow-up. Prognostic accuracy of each score was assessed using Receiver Operating Characteristic(ROC) curve analysis. ICH-FOS risk categories were created for mortality and poor functional outcomes.

Results: There were 1660 patients with sICH admitted to Hamad General Hospital available for analysis. Mean age 49(SD 12) years, median GCS 15(IQR 11-15), median NIHSS 12(IQR 5-19). At 90-day follow-up, 124(11.3 %) died and 396(36 %) had poor functional outcome. ATACH included 1000 non-anti-coagulant related sICH patients with supratentorial bleeds without intra-ventricular extension(IVH). Mean age 62(SD 12) years, median GCS 15(IQR 13-15), median NIHSS 11(IQR 6-16). At 90-day follow-up, 54(5.9 %) patients died and 342(37.3 %) had poor functional outcomes. Patients in ATACH-2 were older, had 4-fold increased odds of having a prior stroke, and were 4-times more likely to be smokers. There were more lobar bleeds in Qatar and a higher proportion of patients in Qatar died at 90-days(11.3 v 5.9, p < 0.001). No difference in the rate of poor functional outcomes was noted. ICH-FOS had the largest AUC in ATACH(0.83, 95 % CI 0.77-0.89) and Qatar(0.81, 95 % CI 0.77-0.84) databases for predicting 3-month mortality, and similarly for unfavourable functional outcomes(mRS 4-6), with AUC's in ATACH(0.83, 95 % CI 0.79-0.85) and Qatar(0.85, 95 % CI 0.82-0.87), respectively.

Conclusion: ICH-FOS was the most accurate predictor of 90-day mortality and poor functional outcome in both Qatari and ATACH-2 patients with non-anticoagulant related supratentorial sICH without IVH. Our study extends the utility of the ICH-FOS from a Chinese population to both Middle-Eastern and Western populations.

Keywords: ICH-FOS; Intracerebral hemorrhage; Prognostic scores.