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Int J Stroke. 2015 Oct;10(7):1101-7. doi: 10.1111/ijs.12518. Epub 2015 Jun 4.

Poor utility of grading scales in acute intracerebral hemorrhage: results from the INTERACT2 trial.

Author information

1
The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
2
Royal Prince Alfred Hospital, Sydney, NSW, Australia.
3
The George Institute for Global Health, University of Oxford, Oxford, UK.
4
Seta University of Medical Science, Tsukinowa-cho, Otsu, Shiga, Japan.
5
Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
6
Department of Neurology, APHP - Hôpital Lariboisière and DHU NeuroVasc Paris - Sorbonne, Univ Paris Diderot - Sorbonne Paris Cité, Paris, France.
7
Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
8
Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Centro de Neurociencias, Universidad del Desarrollo, Santiago, Chile.
9
Departamento de Ciencias Neurológicas, Universidad de Chile, Santiago, Chile.
10
Department of Neurology, Peking University First Hospital, Beijing, China.
11
Hejian City People's Hospital, Hebei, China.
12
Stroke unit, Pitié-Salpêtriere Hospital, Paris, AP-HP, France.
13
Salford Royal NHS Foundation Trust, Salford, UK.
14
The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.

Abstract

BACKGROUND:

Several simple clinical grading scores have been developed for intracerebral hemorrhage, primarily to predict 30-day mortality.

AIMS:

We aimed to determine the accuracy of three popular scores (original intracerebral hemorrhage, modified intracerebral hemorrhage, and intracerebral hemorrhage grading scale) on 30-day mortality and 90-day death or major disability, and whether the magnitude of benefit varies according to prognosis graded by the three predictive scores.

METHODS:

Data from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial which included 2839 intracerebral hemorrhage patients (<6 hours) and elevated systolic blood pressure (150-220 mmHg), randomized to intensive (target systolic blood pressure <140 mmHg) or guideline-based (<180 mmHg) blood pressure management. Discrimination of scales for predicting death and poor outcome (modified Rankin scale 3-6) was evaluated in area under receiver operator characteristic curves.

RESULTS:

Among 2556 (90%) participants with available data, the modified intracerebral hemorrhage had the highest discrimination (receiver operator characteristic 0·75) for 90-day poor outcome compared with the original intracerebral hemorrhage (receiver operator characteristic 0·68) and intracerebral hemorrhage grading scale (receiver operator characteristic 0·69). All scores had good positive predictive value (approximately 80-90%) for poor outcome but poor sensitivity and positive predictive value for death. The scores do not clearly discriminate a patient group most likely to benefit from blood pressure lowering.

CONCLUSIONS:

Intracerebral hemorrhage prognostic scores are not useful in defining patients at high probability of early death, but they are reliable for predicting poor outcome, defined by death or major disability. Potential benefits of early intensive blood pressure lowering are broadly applicable across grades of severity defined by such scores.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00716079.

KEYWORDS:

BP lowering treatment; ICH scales; INTERACT2; intracerebral hemorrhage; prognosis

PMID:
26044442
DOI:
10.1111/ijs.12518
[Indexed for MEDLINE]

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