Tiago Gregório1,2, Sara Pipa3, Pedro Cavaleiro4, Gabriel Atanásio3, Inês Albuquerque5, Paulo Castro Chaves5,6,7, Luís Azevedo8. 1. Department of Internal Medicine, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal. tiago.gregorio@chvng.min-saude.pt. 2. Stroke Unit, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal. tiago.gregorio@chvng.min-saude.pt. 3. Department of Internal Medicine, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal. 4. Intensive Care Department, Algarve University Hospital Centre, Rua Leão Penedo, 8000-386, Faro, Portugal. 5. Department of Internal Medicine, São João Hospital Centre, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal. 6. Stroke Unit, São João Hospital Centre, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal. 7. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal. 8. Centre for Health Technology and Services Research and Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
Abstract
BACKGROUND/ OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND/ OBJECTIVE: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. METHODS: 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 ICHpatients. 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. RESULTS: 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. CONCLUSIONS: The ICH score is the most extensively validated score in ICHpatients 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.
Entities:
Keywords:
Cerebral hemorrhage; Decision support techniques; Morbidity; Mortality; Prognosis
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