1
|
Akhtar N, Kate M, Kamran S, Joseph S, Morgan D, Uy R, Babu B, Shanti S, Shuaib A. Short-term functional outcomes of patients with acute intracerebral hemorrhage in the native and expatriate population. Front Neurol 2024; 15:1384985. [PMID: 38756212 PMCID: PMC11097684 DOI: 10.3389/fneur.2024.1384985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Functional outcomes in patients with intracerebral hemorrhage (ICH) have not been well characterized in the Middle East and North Africa Region. We report the 30 and 90-day clinical outcomes in the native and expatriate of Qatar with ICH. Methods We evaluated the Glasgow Coma Scale (GCS), NIHSS, and imaging in the Qatar Stroke Registry (2013-22). The outcome measures were a modified Rankin Scale (mRS) at 90 days and mortality at 30 and 90 days. Unfavorable outcome was defined as mRS of 4-6. We performed non-parametric ROC analyses to measure the concordance index (C-index) to assess the goodness-of-fit of ICH score for predicting 30 day and 90-day mortality and functional outcome. Results 1,660 patients (median age of 49 (41.5-58) years; male 83.1%, expatriates 77.5%) with ICH, including supratentorial deep in 65.2%, cortical in 16.2%, infratentorial 16% and primary intraventricular in 2.5% were studied. The median baseline ICH volume was 7.5 (3.2-15.8) ml. An unfavorable outcome was seen in 673 (40.5%) patients at 90 days. The unfavorable 90-day outcome (mRS 4-6) was 49.2% in the native population vs. 44.4% in Africans, 39.0% in South Asian, 35.3% in Far Eastern, and 7.7% in Caucasians, p < 0.001. Mortality at 30 days and 90 days was 10.4 and 15.1%. Increasing age [OR (95% CI), 1.02 (1.00-1.03)], lower GCS [0.77 (0.73-0.80)], prior use of antiplatelet medications [1.82 (1.19-2.08)], higher ICH volume [1.03 (1.02-1.04)], and presence of any intraventricular hemorrhage [1.57(1.19-2.08)], were associated with unfavorable outcome. Conclusion In this relatively younger ICH cohort more than 75% were expatriates. The ICH volume, 90-day unfavorable outcome and mortality was lower in the expatriates compared to the local Arab population, likely related to the younger age and smaller size of the hemorrhages. Prognostic scoring systems may have to be modified in this population to avoid early withdrawal of care.
Collapse
Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mahesh Kate
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shobhna Shanti
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
2
|
Komolafe MA, Sunmonu T, Akinyemi J, Sarfo FS, Akpalu A, Wahab K, Obiako R, Owolabi L, Osaigbovo GO, Ogbole G, Tiwari HK, Jenkins C, Lackland DT, Fakunle AG, Uvere E, Akpa O, Dambatta HA, Akpalu J, Onasanya A, Olaleye A, Ogah OS, Isah SY, Fawale MB, Adebowale A, Okekunle AP, Arnett D, Adeoye AM, Agunloye AM, Bello AH, Aderibigbe AS, Idowu AO, Sanusi AA, Ogunmodede A, Balogun SA, Egberongbe AA, Rotimi FT, Fredrick A, Akinnuoye AO, Adeniyi FA, Calys-Tagoe B, Adebayo P, Arulogun O, Agbogu-Ike OU, Yaria J, Appiah L, Ibinaiye P, Singh A, Adeniyi S, Olalusi O, Mande A, Balogun O, Akinyemi R, Ovbiagele B, Owolabi M. Clinical and neuroimaging factors associated with 30-day fatality among indigenous West Africans with spontaneous intracerebral hemorrhage. J Neurol Sci 2024; 456:122848. [PMID: 38171072 PMCID: PMC10888524 DOI: 10.1016/j.jns.2023.122848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. METHODS The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). RESULTS Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02-1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82-18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02-7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15-0.85). CONCLUSION This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans.
Collapse
Affiliation(s)
| | - Taofiki Sunmonu
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | | | | | | | | | - Ezinne Uvere
- College of Medicine, University of Ibadan, Nigeria
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | | | - Josephine Akpalu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Akinola Onasanya
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Adeniji Olaleye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Sulaiman Y Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Micheal B Fawale
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Akintunde Adebowale
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Akinkunmi P Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Donna Arnett
- College of Public Health, University of Kentucky, USA
| | | | | | - Abiodun H Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adeniyi S Aderibigbe
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Ahmed O Idowu
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Ahmad A Sanusi
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Adebimpe Ogunmodede
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Simon A Balogun
- Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | | | - Folorunso T Rotimi
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Adeyemi Fredrick
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Andrew O Akinnuoye
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Folu A Adeniyi
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Arti Singh
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Sunday Adeniyi
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Aliyu Mande
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Olayemi Balogun
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Rufus Akinyemi
- University College Hospital, Ibadan, Nigeria; Federal Medical Centre, Abeokuta, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California, San-Francisco, USA
| | - Mayowa Owolabi
- University College Hospital, Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria.
| |
Collapse
|
3
|
Head-to-head comparison of prognostic models of spontaneous intracerebral hemorrhage: tools for personalized care and clinical trial in ICH. Neurol Res 2021; 44:146-155. [PMID: 34431446 DOI: 10.1080/01616412.2021.1967678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To systematically compare 27 ICH models with regard to mortality and functional outcome at 1-month, 3-month and 1-year after ICH. The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1-month, 3-month and 1-year after ICH, respectively. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. A total number of 1575 patients were included. The mean age was 57.2 ± 14.3 and 67.2% were male. The median NIHSS score on admission was 11 (IQR: 3-21). For predicting mortality at 3-month after ICH, AUROC of 27 ICH models ranged from 0.604 to 0.856. In pairwise comparison, the ICH-FOS (0.856, 95%CI = 0.835-0.878, P < 0.001) showed statistically better discrimination than other models for mortality at 3-month after ICH (all P < 0.05). For predicting poor functional outcome (mRS≥3) at 3-month after ICH, AUROC of 27 ICH models ranged from 0.602 to 0.880. In pairwise comparison with other prediction models, the ICH-FOS was superior in predicting poor functional outcome at 3-month after ICH (all P < 0.001). The ICH-FOS showed the largest Cox and Snell R-square. Similar results were verified for mortality and poor functional outcome at 1-month and 1-year after ICH. Several risk models are externally validated to be effective for risk stratification and outcome prediction after ICH, especially the ICH-FOS, which would be useful tools for personalized care and clinical trial in ICH.
Collapse
|
4
|
Damien C, Cisse F, Ligot N, Toure ML, Konaté M, Barry SD, Saw M, Naeije G. Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study. Trop Med Int Health 2020; 26:166-172. [PMID: 33159424 DOI: 10.1111/tmi.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. METHODS Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. RESULTS Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. CONCLUSIONS Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.
Collapse
Affiliation(s)
- C Damien
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - F Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - N Ligot
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M L Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - M Konaté
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - S D Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - M Saw
- Centre de Diagnostic Caisse Nationale de Sécurité Sociale, Conakry, Guinea
| | - G Naeije
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
5
|
Mardanshahi Z, Tayebi M, Shafiee S, Barzin M, Shafizad M, Alizadeh-Navaei R, Gholinataj A. Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double inversion recovery. Biomedicine (Taipei) 2020; 10:29-35. [PMID: 33854932 PMCID: PMC7735974 DOI: 10.37796/2211-8039.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of subarachnoid hemorrhage (SAH) especially at the subacute stage is still a challenging issue using the conventional imaging modalities. Here we evaluated the role of double inversion recovery (DIR) sequence of MRI compared with the conventional gradient-recalled echo (GRE)-T2*-W and susceptibility-weighted imaging (SWI) sequences in the diagnosis of subacute SAH. MATERIALS AND METHODS This prospective study was conducted on 21 patients with SAH, which were diagnosed using CT scan at the initial step. In the third week after the injury (14-20 days), all patients underwent a brain MRI exam that included T2*-W, SWI, and DIR imaging sequences. All images were independently read by two radiologists, who were blinded to the clinical history of the patients. The presence or absence of SAH was reviewed and assessed in 6 anatomical regions. RESULTS On the DIR images, 20 patients were found to have at least one subarachnoid signal abnormality, while the SWI and T2*-W images identified SAH areas on 17 and 15 patients, respectively. The highest rate of inter-observer consensus by the DIR sequence was found in the interhemispheric fissure and perimesencephalic area (k = 1). Also, a highest rate of inter-observer consensus using SWI was found in the interhemispheric fissure and posterior fossa cistern area (k = 1). A weak agreement was found in frontal-parietal convexity using SWI (k = 0.447), and in posterior fossa cistern by the T2* sequence (k = 0.447). CONCLUSION In conclusion, the DIR sequence was more reliable at identifying signal abnormalities in subacute SAH patients than the T2*-W and SWI sequence, and is suggested as a promising imaging technique for detecting hemorrhagic areas without considering the anatomical distribution of SAH.
Collapse
Affiliation(s)
- Zahra Mardanshahi
- Department of Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Tayebi
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sajad Shafiee
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Misagh Shafizad
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdolmajid Gholinataj
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author at: E-mail address: (A. Gholinataj)
| |
Collapse
|
6
|
Chien TY, Lee ML, Wu WL, Ting HW. Exploration of Medical Trajectories of Stroke Patients Based on Group-Based Trajectory Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3472. [PMID: 31540463 PMCID: PMC6765978 DOI: 10.3390/ijerph16183472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 12/21/2022]
Abstract
A high mortality rate is an issue with acute cerebrovascular disease (ACVD), as it often leads to a high medical expenditure, and in particular to high costs of treatment for emergency medical conditions and critical care. In this study, we used group-based trajectory modeling (GBTM) to study the characteristics of various groups of patients hospitalized with ACVD. In this research, the patient data were derived from the 1 million sampled cases in the National Health Insurance Research Database (NHIRD) in Taiwan. Cases who had been admitted to hospitals fewer than four times or more than eight times were excluded. Characteristics of the ACVD patients were collected, including age, mortality rate, medical expenditure, and length of hospital stay for each admission. We then performed GBTM to examine hospitalization patterns in patients who had been hospitalized more than four times and fewer than or equal to eight times. The patients were divided into three groups according to medical expenditure: high, medium, and low groups, split at the 33rd and 66th percentiles. After exclusion of unqualified patients, a total of 27,264 cases (male/female = 15,972/11,392) were included. Analysis of the characteristics of the ACVD patients showed that there were significant differences between the two gender groups in terms of age, mortality rate, medical expenditure, and total length of hospital stay. In addition, the data were compared between two admissions, which included interval, outpatient department (OPD) visit after discharge, OPD visit after hospital discharge, and OPD cost. Finally, the differences in medical expenditure between genders and between patients with different types of stroke-ischemic stroke, spontaneous intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH)-were examined using GBTM. Overall, this study employed GBTM to examine the trends in medical expenditure for different groups of stroke patients at different admissions, and some important results were obtained. Our results demonstrated that the time interval between subsequent hospitalizations decreased in the ACVD patients, and there were significant differences between genders and between patients with different types of stroke. It is often difficult to decide when the time has been reached at which further treatment will not improve the condition of ACVD patients, and the findings of our study may be used as a reference for assessing outcomes and quality of care for stroke patients. Because of the characteristics of NHIRD, this study had some limitations; for example, the number of cases for some diseases was not sufficient for effective statistical analysis.
Collapse
Affiliation(s)
- Ting-Ying Chien
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 320, Taiwan
- Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan City 320, Taiwan
- Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Mei-Lien Lee
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Wan-Ling Wu
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Hsien-Wei Ting
- Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan City 320, Taiwan.
- Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242, Taiwan.
| |
Collapse
|
7
|
Gregório T, Pipa S, Cavaleiro P, Atanásio G, Albuquerque I, Chaves PC, Azevedo L. Prognostic models for intracerebral hemorrhage: systematic review and meta-analysis. BMC Med Res Methodol 2018; 18:145. [PMID: 30458727 PMCID: PMC6247734 DOI: 10.1186/s12874-018-0613-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/07/2018] [Indexed: 12/23/2022] Open
Abstract
Background Prognostic tools for intracerebral hemorrhage (ICH) patients are potentially useful for ascertaining prognosis and recommended in guidelines to facilitate streamline assessment and communication between providers. In this systematic review with meta-analysis we identified and characterized all existing prognostic tools for this population, performed a methodological evaluation of the conducting and reporting of such studies and compared different methods of prognostic tool derivation in terms of discrimination for mortality and functional outcome prediction. Methods PubMed, ISI, Scopus and CENTRAL were searched up to 15th September 2016, with additional studies identified using reference check. Two reviewers independently extracted data regarding the population studied, process of tool derivation, included predictors and discrimination (c statistic) using a predesignated spreadsheet based in the CHARMS checklist. Disagreements were solved by consensus. C statistics were pooled using robust variance estimation and meta-regression was applied for group comparisons using random effect models. Results Fifty nine studies were retrieved, including 48,133 patients and reporting on the derivation of 72 prognostic tools. Data on discrimination (c statistic) was available for 53 tools, 38 focusing on mortality and 15 focusing on functional outcome. Discrimination was high for both outcomes, with a pooled c statistic of 0.88 for mortality and 0.87 for functional outcome. Forty three tools were regression based and nine tools were derived using machine learning algorithms, with no differences found between the two methods in terms of discrimination (p = 0.490). Several methodological issues however were identified, relating to handling of missing data, low number of events per variable, insufficient length of follow-up, absence of blinding, infrequent use of internal validation, and underreporting of important model performance measures. Conclusions Prognostic tools for ICH discriminated well for mortality and functional outcome in derivation studies but methodological issues require confirmation of these findings in validation studies. Logistic regression based risk scores are particularly promising given their good performance and ease of application. Electronic supplementary material The online version of this article (10.1186/s12874-018-0613-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tiago Gregório
- Department of Internal Medicine, Vila Nova de Gaia Hospital Cente, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal. .,Stroke Unit, Vila Nova de Gaia Hospital Center, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | - Sara Pipa
- Department of Internal Medicine, Vila Nova de Gaia Hospital Cente, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Pedro Cavaleiro
- Intensive Care Department, Algarve University Hospital Center, Rua Leão Penedo, 8000-386, Faro, Portugal
| | - Gabriel Atanásio
- Department of Internal Medicine, Vila Nova de Gaia Hospital Cente, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Inês Albuquerque
- Department of Internal Medicine, São João Hospital Center, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Paulo Castro Chaves
- Department of Internal Medicine, São João Hospital Center, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.,Stroke Unit, São João Hospital Center, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Luís Azevedo
- Center for Health Technology and Services Research & Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| |
Collapse
|
8
|
Chen J, Zhang D, Li Z, Dong Y, Han K, Wang J, Hou L. Lateral Ventricular Volume Asymmetry Predicts Poor Outcome After Spontaneous Intracerebral Hemorrhage. World Neurosurg 2018; 110:e958-e964. [DOI: 10.1016/j.wneu.2017.11.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 02/03/2023]
|
9
|
Adeleye AO, Osazuwa UA, Ogbole GI. The Clinical Epidemiology of Spontaneous ICH in a Sub-Sahara African Country in the CT Scan Era: A Neurosurgical In-Hospital Cross-Sectional Survey. Front Neurol 2015; 6:169. [PMID: 26300843 PMCID: PMC4525060 DOI: 10.3389/fneur.2015.00169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background There is paucity of data-driven scientific reports from sub-Saharan Africa on the burden of spontaneous intracerebral hemorrhage (sICH). We have maintained a prospective consecutive in-hospital database of cases of sICH referred for neurosurgical intervention over a 5-year period. Methods This is a cross-sectional descriptive study of the clinical epidemiology and brain computed tomography (CT) characterization of sICH from the database in this region in the current era. Results There were 63 subjects, 38 (60.3%) males, aged 28–85 years, mean 55.7 (SD, 12.7), the modal age distribution being the sixth decade. Uncontrolled hypertension was the main predisposition in the study: present, premorbid, in 79%, but uncontrolled in 88% of these known cases, and exhibited malignant derangements of blood pressure in more than half. The clinical ictus to in-hospital presentation was delayed, median 72 h; was in severe clinical state in 70%, 57% was comatose; and was complicated with fever in 57% and respiratory morbidity in 55.6%. The main clinical symptomatology was hemiparesis, headache, vomiting, and aphasia. The sICH was supratentorial on brain CT in 90.5%, ganglionic in 50.8%, and thalamic in 58.3% of the latter. The bleed had CT evidence of mass effect and intraventricular extension (IVH) in more than half. Twenty-three patients (36.5%) underwent operative interventions. Conclusion In this patient population, sICH is mainly ganglionic and thalamic in location with significant rate of associated IVH. In-hospital clinical presentation is delayed, and in a critical state, the bleeding is uncontrolled hypertension related in >95%.
Collapse
Affiliation(s)
- Amos Olufemi Adeleye
- Department of Surgery, Division of Neurological Surgery, College of Medicine, University College Hospital (UCH), University of Ibadan , Ibadan , Nigeria
| | - Uyiosa A Osazuwa
- Department of Neurological Surgery, University College Hospital (UCH) , Ibadan , Nigeria
| | - Godwin I Ogbole
- Department of Radiology, College of Medicine, University College Hospital (UCH), University of Ibadan , Ibadan , Nigeria
| |
Collapse
|
10
|
Ji R, Shen H, Pan Y, Wang P, Liu G, Wang Y, Li H, Zhao X, Wang Y. A novel risk score to predict 1-year functional outcome after intracerebral hemorrhage and comparison with existing scores. Crit Care 2013; 17:R275. [PMID: 24289116 PMCID: PMC4056008 DOI: 10.1186/cc13130] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 10/24/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction Spontaneous intracerebral hemorrhage (ICH) is one of leading causes of mortality and morbidity worldwide. Several predictive models have been developed for ICH; however, none of them have been consistently used in routine clinical practice or clinical research. In the study, we aimed to develop and validate a risk score for predicting 1-year functional outcome after ICH (ICH Functional Outcome Score, ICH-FOS). Furthermore, we compared discrimination of the ICH-FOS and 8 existing ICH scores with regard to 30-day, 3-month, 6-month, and 1-year functional outcome and mortality after ICH. Methods The ICH-FOS was developed based on the China National Stroke Registry, in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1 year after ICH. Multivariable logistic regression was performed to determine independent predictors, and β-coefficients were used to generate scoring system of the ICH-FOS. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. Results The overall 1-year poor functional outcome (mRS ≥ 3) was 46.7% and 44.9% in the derivation (n = 1,953) and validation (n = 1,302) cohorts, respectively. A 16-point ICH-FOS was developed from the set of independent predictors of 1-year poor functional outcome after ICH including age (P < 0.001), admission National Institutes of Health Stroke Scale score (P < 0.001), Glasgow Coma Scale score (P < 0.001), blood glucose (P = 0.002), ICH location (P < 0.001), hematoma volume (P < 0.001), and intraventricular extension (P < 0.001). The ICH-FOS showed good discrimination (AUROC) in the derivation (0.836, 95% CI: 0.819-0.854) and validation (0.830, 95% CI: 0.808-0.852) cohorts. The ICH-FOS was well calibrated (Hosmer-Lemeshow test) in the derivation (P = 0.42) and validation (P = 0.39) cohort. When compared to 8 prior ICH scores, the ICH-FOS showed significantly better discrimination with regard to 1-year functional outcome and mortality after ICH (all P < 0.0001). Meanwhile, the ICH-FOS also demonstrated either comparable or significantly better discrimination for poor functional outcome and mortality at 30-day, 3-month, and 6-month after ICH. Conclusion The ICH-FOS is a valid clinical grading scale for 1-year functional outcome after ICH. Further validation of the ICH-FOS in different populations is needed.
Collapse
|