Establishment And Dreliminary Evaluation Of Prediction Score For Early Hematoma Expansion After Intracerebral Hemorrhage

Purpose:Intracerebral hemorrhage is one of the common diseases in department of neurosurgery and only 12%to 39%of the survivors are capable of living independently.Early hematoma expansion occurs in about 20%to 30%of intracerebral hemorrhage patients within 24h after onset,accompanied by re-bleeding occasionally.Early hematoma expansion is an independent risk factor for disability and death in patients with intracerebral hemorrhage,so the timely assessment and prevention of early hematoma expansion becomes the focus of current research.Therefore,it is of great value to use simple and effective predictors to screen out the high-risk patients who may have early hematoma expansion and make targeted treatments as soon as possible to curb the early deterioration of intracerebral hemorrhage and improve the prognosis.Based on this,our research group aimed to propose a prediction score for early hematoma expansion after intracerebral hemorrhage and evaluate its effect.Methods:A retrospective study was conducted to analyze 317 patients of intracerebral hemorrhage admitted to the Second Affiliated Hospital of Soochow University from January 2016 to May 2018 by electronic medical records,and clinical data of the patients were recorded.Inclusion criteria:1.The first CT scan was acquired within 24h after the onset and the diagnosis was acute intracerebral hemorrhage;2.Age?18.Exclusion criteria:1.Secondary intracerebral hemorrhage(cerebral tumor,traumatic brain injury,arteriovenous malformation,cerebral aneurysm,hemorrhagic transformation of cerebral infarction);2.Emergency surgery was performed before the second CT scan;3.CT was not re-examined within 72h after the first scan.The subjects were divided into early hematoma expansion group and no early hematoma expansion group.Variables with P<0.05 between groups were included in the multivariate logistic regression.As a result,risk factors with P<0.05 in regression were added into score.The assigned scores for each item were derived by parameter estimates(? coefficients)from the regression and increased proportionately to the nearest integer to propose a prediction seore.The area under receiver operating characteristic(ROC)curve was used to evaluate discrimination,Hosmer-Lemeshow goodness-of-fit statistic and calibration plot were test for accuracy,and decision curve analysis(DCA)was used to evaluate its clinical utility.Finally,this score was validated in the development cohort.Results:Glasgow coma scale(GCS)?8,ultraearly hematoma growth?2.7ml/h,non-enhanced CT signs(island sign,black hole sign,blend sign,niveau formation)exist one or more and history of anticoagulants,were independent risk factors for early hematoma expansion(P<0.05).Therefore,the above four items were included as scoring items to propose the prediction score.The area under ROC curve of score was 0.854(95%CI,0.803?0.904);P<0.001)suggesting its strong discrimination.Hosmer-Lemeshow goodness-of-fit test presented ?2=3.323,P=0.344 and the maximum deviation and average deviation of the score were 0.070,0.028 and had a high degree of fitting by passing through the origin in calibration plot,so the score was accurate.The DCA showed the score had clinical utility,for the score far away from the two extreme curves,with a high net benefit and a wide range of optional threshold probability.After validated in the development cohort,in general,the incidence of early hematoma expansion increased with higher scores.When 4.5 was chosen as the cutoff value to dichotomize the score,the sensitivity,specificity and accuracy of the high-risk group(score?4.5)were 0.77,0.85 and 0.83.Conclusion:The score included 4 items:Glasgow coma scale(GCS)?8,ultraearly hematoma growth?2.7ml/h,non-enhanced CT signs(island sign,black hole sign,blend sign,niveau formation)exist one or more and history of anticoagulants,4.5 was chosen as the cutoff value to dichotomize the score.In the era of evidence-based and precise medicine,this score is convenient and reliable for clinicians to accurately judge the patients' condition and to determine the personalized?stratified intervention,which could improve the clinical prognosis and avoid excessive medical treatments to save medical resources.