gms | German Medical Science

Objective: Spontaneous intracerebral haemorrhage (ICH) is associated with significant morbidity and mortality. In several studies no outcome benefit of surgical treatment could be demonstrated resulting into individual treatment decision-making. Especially, minimally invasive surgical treatments such as fibrinolytic therapy seem to be a suitable surgical treatment option in this vulnerable patient collective. The ICH-score allows an early mortality estimation and can be applied as a selection tool for fibrinolytic therapy. The purpose of this study was to investigate if the additional use of APACE II score leads to a more reliable patient selection for fibrinolytic therapy.

Methods: We performed a retrospective study of patients ICH treated by fibrinolytic therapy between 2010 and 2020. Demographic and clinical parameters, additionally clinical grading scales (ICH-score and APACHE II score) were analysed. Predictive values of Apache II score on prognosis were assessed for all patients as well as for individual ICH-score subgroups by area under the receiver operating characteristics curve (AUROC) statistics. Endpoints were defined as in-hospital mortality and poor functional outcome (modified Rankin Scale [mRS] = 5-6).

Results: A total of 280 patients were analysed, 129 of whom were female. The mean age was 70 years, and the median ICH-score was 3. The following mortality rates were found depending on the ICH-score: 0= 0% (0/1), 1= 0% (0/21), 2= 10% (7/70), 3= 20% (22/110), 4= 70.1% (47/67), 5= 100% (11). The mean Apache II score was 20.9 ± 5.7, whereby ICH-survivors had a significant lower score (p=0.000). The AUC of the APACHE II score for all patients was 0.87 (p<0.001) for in-hospital mortality and 0.78 (p<0.001) for poor outcome. While focusing on ICH-score subgroup 4, APACHE II score with a cut-off value of 24.5 showed good discrimination power for mortality (AUC=0.83, p<0.001) as well as for functional outcome (AUC=0.87, p<0.001).

Conclusion: While ICH-scores 1, 2, 3 and 5 facilitate a conclusive prognosis estimation in ICH-patients receiving fibrinolytic therapy, this is not as much decisive in the subgroup with ICH-score 4. An additional application of APACHE II score increases the discrimination power of ICH-score 4 enabling a more precise appraisal of mortality and of functional outcome, which may be supportive during the selection of patients with ICH-score 4 for fibrinolytic therapy.