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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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ICH-Score allows a reliable prediction of mortality in patients with spontaneous intracerebral hemorrhage managed by fibrinolytic therapy

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  • Bogdan Iliev - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Vesna Malinova - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.25.02

doi: 10.3205/17dgnc536, urn:nbn:de:0183-17dgnc5360

Published: June 9, 2017

© 2017 Iliev et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. An estimation of the prognosis would be helpful for the treatment decision-making in patients with ICH. The ICH-score was established in 2001 (Hemphill et al. Stroke) to estimate the 30-day mortality in conservatively treated patients with ICH based on known prognostic risk factors (age, poor clinical status, intraventricular hemorrhage and hematoma volume). We evaluated the reproducibility of the ICH-score for the estimation of the prognosis in ICH patients undergoing application of recombinant tissue Plasminogen Activator (rtPA) and subsequent clot lysis.

Methods: We performed a retrospective analysis of patients with supratentorial ICH managed by fibrinolytic therapy and evaluated the 30-day mortality. Then, the ICH-Score was applied to match the mortality in our patients with the mortality predicted by the ICH-Score. The ICH-Score (range 0-5) is based on parameters available at the time of diagnosis of ICH: age (<80=0 vs. >80=1), hematoma volume (<30ml=0 vs. >30ml=1), intraventricular expansion (no=0, yes=1) and initial clinical status according to the Glasgow Coma Scale (3-4=2, 5-12=1 and 13-15=0). The ICH-Score predicts the following mortality rates in conservatively treated patients with ICH: 0 = 0%, 1=13%, 2=26%, 3=72%, 4=97%, 5=100%.

Results: A total of 233 patients with ICH treated at our department by fibrinolytic therapy were analyzed. The mean age of the patients was 69 years (range 30-93) and the mean initial hematoma volume was 55ml. The 30-day mortality rate was 30% (70/233). We found a significant correlation of 30-day mortality with an intial hematoma volume >30ml (linear regression p=0.001), intraventricular hemorrhage (linear regression p=0.003) and age >80 years (linear regression p=0.01). The ICH-Score showed a significant correlation with 30-day mortality (linear regression p<0.0001). The ICH-Score estimated the following 30-day mortality rates in our cohort: 1=0% (0/13), 2=0% (0/51), 3=1.3% (1/82), 4=43% (13/31), 5=100% (56/56).

Conclusion: The ICH-Score not only allows a reliable estimation of the 30-day mortality in patients with supratentorial ICH treated conservatively but also treated by clot lysis. Compared to conservatively treated patients with supratentorial ICH the fibrinolytic therapy reduced the 30-day mortality in the patients with ICH-Score 1-4. Patients with ICH-Score 5 do not have a benefit of the fibrinolytic therapy and should no longer be considered to be surgical candidates.