Severity assessment in maximally treated ICH patients: The max-ICH score
OBJECTIVE:As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (
Gespeichert in:
| Veröffentlicht in: | Neurology 2017-08, Vol.89 (5), p.423-431 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 431 |
|---|---|
| container_issue | 5 |
| container_start_page | 423 |
| container_title | Neurology |
| container_volume | 89 |
| creator | Sembill, Jochen A Gerner, Stefan T Volbers, Bastian Bobinger, Tobias Lücking, Hannes Kloska, Stephan P Schwab, Stefan Huttner, Hagen B Kuramatsu, Joji B |
| description | OBJECTIVE:As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early ( |
| doi_str_mv | 10.1212/WNL.0000000000004174 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1916709852</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1916709852</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3054-31aae63c479198f03e3af88e93008d47dd1298a1a465b418a2da3e9cca2033603</originalsourceid><addsrcrecordid>eNp9kE1Lw0AQhhdRbP34ByI5ekndryS73qSoLRQ9WNHbMk0mNLpp6u7G2n9vSquIB-cyMPO87zAvIWeMDhhn_PL5fjKgv0qyTO6RPkt4GqeCv-yTPqVcxUJlqkeOvH-ltFtm-pD0uEoznVLeJ6NH_EBXhXUE3qP3NS5CVC2iGj6rGqxdR8EhBCyi8XAULSFUHeCvoukcN0y8mfq8cXhCDkqwHk93_Zg83d5Mh6N48nA3Hl5P4lzQRMaCAWAqcplpplVJBQoolUItKFWFzIqCca2AgUyTmWQKeAECdZ4Dp0KkVByTi63v0jXvLfpg6srnaC0ssGm9YZqlGdUq4R0qt2juGu8dlmbpuqfc2jBqNhmaLkPzN8NOdr670M5qLH5E36F1gNoCq8YGdP7Ntit0Zo5gw_x_7y8yLHwE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1916709852</pqid></control><display><type>article</type><title>Severity assessment in maximally treated ICH patients: The max-ICH score</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>Sembill, Jochen A ; Gerner, Stefan T ; Volbers, Bastian ; Bobinger, Tobias ; Lücking, Hannes ; Kloska, Stephan P ; Schwab, Stefan ; Huttner, Hagen B ; Kuramatsu, Joji B</creator><creatorcontrib>Sembill, Jochen A ; Gerner, Stefan T ; Volbers, Bastian ; Bobinger, Tobias ; Lücking, Hannes ; Kloska, Stephan P ; Schwab, Stefan ; Huttner, Hagen B ; Kuramatsu, Joji B</creatorcontrib><description>OBJECTIVE:As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (<24 hours) care limitations (ECL), we investigated its interaction with prognostication in maximally treated patients and sought to provide a new unbiased severity assessment tool.
METHODS:This observational cohort study analyzed consecutive ICH patients (n = 583) from a prospective registry over 5 years. We characterized the influence of ECL on overall outcome by propensity score matching and on conventional prognostication using receiver operating characteristic analyses. We established the max-ICH score based on independent predictors of 12-month functional outcome in maximally treated patients and compared it to existing models.
RESULTS:Prevalence of ECL was 19.2% (n = 112/583) and all of these patients died. Yet propensity score matching displayed that 50.7% (n = 35/69) theoretically could have survived, with 18.8% (n = 13/69) possibly reaching favorable outcome (modified Rankin Scale score 0–3). Conventional prognostication seemed to be confounded by ECL, documented by a decreased predictive validity (area under the curve [AUC] 0.67, confidence interval [CI] 0.61–0.73 vs AUC 0.80, CI 0.76–0.83; p < 0.01), overestimating poor outcome (mortality by 44.8%, unfavorable outcome by 10.1%) in maximally treated patients. In these patients, the novel max-ICH score (0–10) integrates strength-adjusted predictors, i.e., NIH Stroke Scale score, age, intraventricular hemorrhage, anticoagulation, and ICH volume (lobar and nonlobar), demonstrating improved predictive accuracy for functional outcome (12 monthsAUC 0.81, CI 0.77–0.85; p < 0.01). The max-ICH score may more accurately delineate potentials of aggressive care, showing favorable outcome in 45.4% (n = 214/471) and a long-term mortality rate of only 30.1% (n = 142/471).
CONCLUSIONS:Care limitations significantly influenced the validity of common prognostication models resulting in overestimation of poor outcome. The max-ICH score demonstrated increased predictive validity with minimized confounding by care limitations, making it a useful tool for severity assessment in ICH patients.</description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000004174</identifier><identifier>PMID: 28679602</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Age Factors ; Aged ; Area Under Curve ; Cerebral Hemorrhage - diagnosis ; Cerebral Hemorrhage - mortality ; Cerebral Hemorrhage - therapy ; Female ; Humans ; Male ; Prognosis ; Propensity Score ; Prospective Studies ; Recovery of Function ; Registries ; ROC Curve ; Severity of Illness Index ; Treatment Outcome</subject><ispartof>Neurology, 2017-08, Vol.89 (5), p.423-431</ispartof><rights>2017 American Academy of Neurology</rights><rights>2017 American Academy of Neurology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3054-31aae63c479198f03e3af88e93008d47dd1298a1a465b418a2da3e9cca2033603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28679602$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sembill, Jochen A</creatorcontrib><creatorcontrib>Gerner, Stefan T</creatorcontrib><creatorcontrib>Volbers, Bastian</creatorcontrib><creatorcontrib>Bobinger, Tobias</creatorcontrib><creatorcontrib>Lücking, Hannes</creatorcontrib><creatorcontrib>Kloska, Stephan P</creatorcontrib><creatorcontrib>Schwab, Stefan</creatorcontrib><creatorcontrib>Huttner, Hagen B</creatorcontrib><creatorcontrib>Kuramatsu, Joji B</creatorcontrib><title>Severity assessment in maximally treated ICH patients: The max-ICH score</title><title>Neurology</title><addtitle>Neurology</addtitle><description>OBJECTIVE:As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (<24 hours) care limitations (ECL), we investigated its interaction with prognostication in maximally treated patients and sought to provide a new unbiased severity assessment tool.
METHODS:This observational cohort study analyzed consecutive ICH patients (n = 583) from a prospective registry over 5 years. We characterized the influence of ECL on overall outcome by propensity score matching and on conventional prognostication using receiver operating characteristic analyses. We established the max-ICH score based on independent predictors of 12-month functional outcome in maximally treated patients and compared it to existing models.
RESULTS:Prevalence of ECL was 19.2% (n = 112/583) and all of these patients died. Yet propensity score matching displayed that 50.7% (n = 35/69) theoretically could have survived, with 18.8% (n = 13/69) possibly reaching favorable outcome (modified Rankin Scale score 0–3). Conventional prognostication seemed to be confounded by ECL, documented by a decreased predictive validity (area under the curve [AUC] 0.67, confidence interval [CI] 0.61–0.73 vs AUC 0.80, CI 0.76–0.83; p < 0.01), overestimating poor outcome (mortality by 44.8%, unfavorable outcome by 10.1%) in maximally treated patients. In these patients, the novel max-ICH score (0–10) integrates strength-adjusted predictors, i.e., NIH Stroke Scale score, age, intraventricular hemorrhage, anticoagulation, and ICH volume (lobar and nonlobar), demonstrating improved predictive accuracy for functional outcome (12 monthsAUC 0.81, CI 0.77–0.85; p < 0.01). The max-ICH score may more accurately delineate potentials of aggressive care, showing favorable outcome in 45.4% (n = 214/471) and a long-term mortality rate of only 30.1% (n = 142/471).
CONCLUSIONS:Care limitations significantly influenced the validity of common prognostication models resulting in overestimation of poor outcome. The max-ICH score demonstrated increased predictive validity with minimized confounding by care limitations, making it a useful tool for severity assessment in ICH patients.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Area Under Curve</subject><subject>Cerebral Hemorrhage - diagnosis</subject><subject>Cerebral Hemorrhage - mortality</subject><subject>Cerebral Hemorrhage - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Prognosis</subject><subject>Propensity Score</subject><subject>Prospective Studies</subject><subject>Recovery of Function</subject><subject>Registries</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Treatment Outcome</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQhhdRbP34ByI5ekndryS73qSoLRQ9WNHbMk0mNLpp6u7G2n9vSquIB-cyMPO87zAvIWeMDhhn_PL5fjKgv0qyTO6RPkt4GqeCv-yTPqVcxUJlqkeOvH-ltFtm-pD0uEoznVLeJ6NH_EBXhXUE3qP3NS5CVC2iGj6rGqxdR8EhBCyi8XAULSFUHeCvoukcN0y8mfq8cXhCDkqwHk93_Zg83d5Mh6N48nA3Hl5P4lzQRMaCAWAqcplpplVJBQoolUItKFWFzIqCca2AgUyTmWQKeAECdZ4Dp0KkVByTi63v0jXvLfpg6srnaC0ssGm9YZqlGdUq4R0qt2juGu8dlmbpuqfc2jBqNhmaLkPzN8NOdr670M5qLH5E36F1gNoCq8YGdP7Ntit0Zo5gw_x_7y8yLHwE</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Sembill, Jochen A</creator><creator>Gerner, Stefan T</creator><creator>Volbers, Bastian</creator><creator>Bobinger, Tobias</creator><creator>Lücking, Hannes</creator><creator>Kloska, Stephan P</creator><creator>Schwab, Stefan</creator><creator>Huttner, Hagen B</creator><creator>Kuramatsu, Joji B</creator><general>American Academy of Neurology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Severity assessment in maximally treated ICH patients: The max-ICH score</title><author>Sembill, Jochen A ; Gerner, Stefan T ; Volbers, Bastian ; Bobinger, Tobias ; Lücking, Hannes ; Kloska, Stephan P ; Schwab, Stefan ; Huttner, Hagen B ; Kuramatsu, Joji B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3054-31aae63c479198f03e3af88e93008d47dd1298a1a465b418a2da3e9cca2033603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Area Under Curve</topic><topic>Cerebral Hemorrhage - diagnosis</topic><topic>Cerebral Hemorrhage - mortality</topic><topic>Cerebral Hemorrhage - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Prognosis</topic><topic>Propensity Score</topic><topic>Prospective Studies</topic><topic>Recovery of Function</topic><topic>Registries</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sembill, Jochen A</creatorcontrib><creatorcontrib>Gerner, Stefan T</creatorcontrib><creatorcontrib>Volbers, Bastian</creatorcontrib><creatorcontrib>Bobinger, Tobias</creatorcontrib><creatorcontrib>Lücking, Hannes</creatorcontrib><creatorcontrib>Kloska, Stephan P</creatorcontrib><creatorcontrib>Schwab, Stefan</creatorcontrib><creatorcontrib>Huttner, Hagen B</creatorcontrib><creatorcontrib>Kuramatsu, Joji B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sembill, Jochen A</au><au>Gerner, Stefan T</au><au>Volbers, Bastian</au><au>Bobinger, Tobias</au><au>Lücking, Hannes</au><au>Kloska, Stephan P</au><au>Schwab, Stefan</au><au>Huttner, Hagen B</au><au>Kuramatsu, Joji B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severity assessment in maximally treated ICH patients: The max-ICH score</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>89</volume><issue>5</issue><spage>423</spage><epage>431</epage><pages>423-431</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><abstract>OBJECTIVE:As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (<24 hours) care limitations (ECL), we investigated its interaction with prognostication in maximally treated patients and sought to provide a new unbiased severity assessment tool.
METHODS:This observational cohort study analyzed consecutive ICH patients (n = 583) from a prospective registry over 5 years. We characterized the influence of ECL on overall outcome by propensity score matching and on conventional prognostication using receiver operating characteristic analyses. We established the max-ICH score based on independent predictors of 12-month functional outcome in maximally treated patients and compared it to existing models.
RESULTS:Prevalence of ECL was 19.2% (n = 112/583) and all of these patients died. Yet propensity score matching displayed that 50.7% (n = 35/69) theoretically could have survived, with 18.8% (n = 13/69) possibly reaching favorable outcome (modified Rankin Scale score 0–3). Conventional prognostication seemed to be confounded by ECL, documented by a decreased predictive validity (area under the curve [AUC] 0.67, confidence interval [CI] 0.61–0.73 vs AUC 0.80, CI 0.76–0.83; p < 0.01), overestimating poor outcome (mortality by 44.8%, unfavorable outcome by 10.1%) in maximally treated patients. In these patients, the novel max-ICH score (0–10) integrates strength-adjusted predictors, i.e., NIH Stroke Scale score, age, intraventricular hemorrhage, anticoagulation, and ICH volume (lobar and nonlobar), demonstrating improved predictive accuracy for functional outcome (12 monthsAUC 0.81, CI 0.77–0.85; p < 0.01). The max-ICH score may more accurately delineate potentials of aggressive care, showing favorable outcome in 45.4% (n = 214/471) and a long-term mortality rate of only 30.1% (n = 142/471).
CONCLUSIONS:Care limitations significantly influenced the validity of common prognostication models resulting in overestimation of poor outcome. The max-ICH score demonstrated increased predictive validity with minimized confounding by care limitations, making it a useful tool for severity assessment in ICH patients.</abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>28679602</pmid><doi>10.1212/WNL.0000000000004174</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0028-3878 |
| ispartof | Neurology, 2017-08, Vol.89 (5), p.423-431 |
| issn | 0028-3878 1526-632X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1916709852 |
| source | MEDLINE; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Age Factors Aged Area Under Curve Cerebral Hemorrhage - diagnosis Cerebral Hemorrhage - mortality Cerebral Hemorrhage - therapy Female Humans Male Prognosis Propensity Score Prospective Studies Recovery of Function Registries ROC Curve Severity of Illness Index Treatment Outcome |
| title | Severity assessment in maximally treated ICH patients: The max-ICH score |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T23%3A54%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Severity%20assessment%20in%20maximally%20treated%20ICH%20patients:%20The%20max-ICH%20score&rft.jtitle=Neurology&rft.au=Sembill,%20Jochen%20A&rft.date=2017-08-01&rft.volume=89&rft.issue=5&rft.spage=423&rft.epage=431&rft.pages=423-431&rft.issn=0028-3878&rft.eissn=1526-632X&rft_id=info:doi/10.1212/WNL.0000000000004174&rft_dat=%3Cproquest_cross%3E1916709852%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1916709852&rft_id=info:pmid/28679602&rfr_iscdi=true |