Artikel
A new IVH Score for predicting 30-day mortality and functional outcome in secondary IVH
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Autoren
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M. Stein
- Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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M. Luecke
- Klinik für Neurochirurgie, Asklepios Klinik Altona, Hamburg
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W. Scharbrodt
- Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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D.-K. Boeker
- Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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A. Joedicke
- Klinik für Neurochirurgie, Vivantes Klinikum Neukölln, Berlin
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M. Oertel
- Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
Text
Objective: Intraventricular extension (IVH) of intracerebral haemorrhage (ICH) was identified as independent predictor of 30-day mortality in previous ICH studies. Untreated acute hydrocephalus may lead to increased ICP with high mortality rates in secondary IVH. To date, no validated clinical grading scale of hydrocephalus exists. The purpose of this study was to test the original ICH (oICH), the modified ICH-A (mICH-A) and the modified ICH-B (mICH-B) scores in an independent cohort of patients with secondary IVH. A new IVH Score was developed and validated with prospective data.
Methods: The new IVH score included 104 patients. The score consisted of the following parameters: the initial GCS score on admission, the volume of hematoma, hydrocephalus, and age ≥70 years. The score ranged from 0 to 7 points. The outcome was determined as 30-day mortality and favourable outcome at 6 months after stroke (mRS 1–3). The IVH, the oICH, the mICH-A, and the mICH-B scores were compared within the retrospective cohort. Receiver operating characteristic (ROC) curves were plotted and the areas under the curves (AUC) were calculated. The new IVH score was validated in a prospective cohort of 55 patients. Different cut-offs of the IVH score were tested to achieve the highest Youden’s index (YI).
Results: AUC in the retrospective cohort were 0.751, 0.833, 0.810 and 0.890 for the original ICH, the mICH-A, the mICH-B, and the new IVH score, respectively. The best AUC for favourable outcome was observed for the mICH-B score (0.889). For the mICH-A and the IVH score an AUC of 0.848 was calculated. The lowest AUC was observed for oICH score with 0.758. The best cut-off point for mortality was an IVH score >3 with a YI of 0.66 (sensitivity 0.87; specificity 0.79) in the retrospective cohort. Mortality rates became high in the prospective cohort with an IVH score >3 points (YI: 0.56, sensitivity: 0.77, specificity: 0.79).
Conclusions: The IVH score is the best and most reliable tool for the prediction of 30-day mortality as well as of favourable functional outcome in secondary IVH. The mICH-B score showed slightly better prediction of favourable outcome. The oICH score was least reliable for predicting 30-day mortality and favourable outcome in secondary IVH.
