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Open Access

Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores

Ronda Lun, Vignan Yogendrakumar, Tim Ramsay, Michel Shamy, Robert Fahed, Magdy H Selim, Dar Dowlatshahi
DOI: 10.1136/svn-2020-000656 Published 24 December 2021
Ronda Lun
1 Department of Medicine, Division of Neurology, Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
2 Clinical Epidemiology Program, School of Epidemiology, Public Health and Preventative Medicine, Ottawa Hospital Research Institute, Ottawa University, Ottawa, Ontario, Canada
3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • ORCID record for Ronda Lun
Vignan Yogendrakumar
1 Department of Medicine, Division of Neurology, Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
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Tim Ramsay
2 Clinical Epidemiology Program, School of Epidemiology, Public Health and Preventative Medicine, Ottawa Hospital Research Institute, Ottawa University, Ottawa, Ontario, Canada
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Michel Shamy
1 Department of Medicine, Division of Neurology, Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
2 Clinical Epidemiology Program, School of Epidemiology, Public Health and Preventative Medicine, Ottawa Hospital Research Institute, Ottawa University, Ottawa, Ontario, Canada
3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Robert Fahed
1 Department of Medicine, Division of Neurology, Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
4 Interventional Neuroradiology, Rothschild Foundation, Paris, Île-de-France, France
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Magdy H Selim
5 Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Dar Dowlatshahi
1 Department of Medicine, Division of Neurology, Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
2 Clinical Epidemiology Program, School of Epidemiology, Public Health and Preventative Medicine, Ottawa Hospital Research Institute, Ottawa University, Ottawa, Ontario, Canada
3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Figure 1
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    Figure 1

    ROC curves for the association between baseline and delayed ICH score for 30-day (A), 90-day (B) and 180-day mortality (C). ICH, intracerebral haemorrhage; ROC, receiver operating characteristic.

  • Figure 2
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    Figure 2

    ROC curves for the association between baseline and delayed ICH score for 30-day (A), 90-day (B) and 180-day poor functional outcome (C). ICH, intracerebral haemorrhage; ROC, receiver operating characteristic.

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  • Table 1

    Components of the original ICH score, modified-ICH score, max-ICH score and FUNC score and their respective weightings

    ICH scoreModified-ICH scoreMax-ICH scoreFUNC score
    Variables (maximum points possible)GCS (2)GCS (2)NIHSS (3)GCS (2)
    ICH volume (1)ICH volume (2)ICH volume (2)ICH volume (4)
    Intraventricular haemorrhage (1)Intraventricular haemorrhage (1)Intraventricular haemorrhage (1)Cognitive impairment (1)
    Location (ie, infratentorial) (1)Oral anticoagulation (1)Location (2)
    Age (1)Age (3)Age (2)
    Total points possible651011
    • GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; NIHSS, National Institutes of Health Stroke Severity Scale.

  • Table 2

    Baseline characteristics of those who were included/excluded from analysis for ICH score, FUNC score and modified-ICH score

    CharacteristicsIncluded (n=277)Excluded (n=16)P value
    Age, years (mean±SD)60.0±11.865.3±13.90.086
    Male sex (n, %)169 (61.0)12 (75.0)0.30
    Medical history (n, %)
     Hypertension227 (81.9)12 (75.0)0.51
     Dementia5 (1.8)01.00
     Diabetes mellitus74 (26.7)1 (6.25)0.08
     Previous stroke26 (9.4)00.34
     Previous ICH10 (3.6)01.00
    Clinical information (mean±SD)
     Treated with DFO139 (50.2%)6 (37.5%)0.442
     Systolic blood pressure (mm Hg)136.0±15.6134.6±16.00.74
     Diastolic blood pressure (mm Hg)70.8±13.672.9±11.80.57
     Baseline GCS13.2±2.212.3±2.20.12
     Delayed GCS13.6±2.310.5±2.5 <0.001
    Radiographic information
     Baseline ICH vol (mL, mean±SD)18.3±1.049.3±8.4 <0.001
     Delayed ICH vol (mL, mean±SD)17.9±1.017.3±9.80.95
     Baseline IVH presence (n, %)116 (41.9)4 (25.0)0.20
     Delayed IVH presence (n, %)119 (43.0)1 (6.3) 0.003
    • Bolded text signifies statistical significance at the level of p < 0.05

    • DFO, deferoxamine mesylate; GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; IVH, intraventricular haemorrhage.

  • Table 3

    Area under the curve values for ROC curves of baseline versus delayed prognostication scores (listed left) for 30-day, 90-day and 180-day mortality, and poor functional outcome (modified Rankin Scale of 4–5) in all patients (placebo treated and DFO treated) meeting inclusion criteria

    Mortality (baseline vs delayed)Poor functional outcome (baseline vs delayed)
    30-day90-day180-day30-day90-day180-day
    Original ICH score 0.73 vs 0.82 (0.002) 0.74 vs 0.82 (0.015) 0.74 vs 0.83 (0.005)0.71 vs 0.74 (0.14)0.74 vs 0.72 (0.34)0.79 vs 0.77 (0.34)
    Modified-ICH score 0.76 vs 0.83 (0.027)0.76 vs 0.82 (0.080) 0.73 vs 0.80 (0.036) 0.71 vs 0.75 (0.033)0.73 vs 0.73 (0.86)0.77 vs 0.76 (0.78)
    Max-ICH score 0.74 vs 0.83 (<0.000) 0.74 vs 0.83 (<0.000) 0.77 vs 0.84 (0.008) 0.77 vs 0.82 (0.011)0.84 vs 0.82 (0.373)0.86 vs 0.82 (0.13)
    FUNC score0.66 vs 0.75 (0.054)0.66 vs 0.74 (0.058)0.70 vs 0.77 (0.061)0.63 vs 0.62 (0.39)0.69 vs 0.65 (0.18)0.68 vs 0.66 (0.43)
    • Statistical significance is highlighted using bold font. P values are represented in parentheses.

    • DFO, deferoxamine mesylate; ICH, intracerebral haemorrhage; ROC, receiver operating characteristic.

Supplementary Materials

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    [svn-2020-000656supp001.pdf]

Additional Files

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  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores
Ronda Lun, Vignan Yogendrakumar, Tim Ramsay, Michel Shamy, Robert Fahed, Magdy H Selim, Dar Dowlatshahi
Stroke and Vascular Neurology Dec 2021, 6 (4) 536-541; DOI: 10.1136/svn-2020-000656

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Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores
Ronda Lun, Vignan Yogendrakumar, Tim Ramsay, Michel Shamy, Robert Fahed, Magdy H Selim, Dar Dowlatshahi
Stroke and Vascular Neurology Dec 2021, 6 (4) 536-541; DOI: 10.1136/svn-2020-000656
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Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores
Ronda Lun, Vignan Yogendrakumar, Tim Ramsay, Michel Shamy, Robert Fahed, Magdy H Selim, Dar Dowlatshahi
Stroke and Vascular Neurology Dec 2021, 6 (4) 536-541; DOI: 10.1136/svn-2020-000656
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