Prognostic index of postoperative mortality for patients with primary intracerebral hemorrhage
Keywords:
intracerebral hematoma, mortality, prognosis.Abstract
Introduction: Spontaneous intracerebral hematoma is the form of stroke with the highest mortality and morbidity rates. There is no consensus as to which patients benefit from surgical evacuation of the hematoma and, furthermore, postoperative mortality is high in most series.Objective: To create a prognostic index of postoperative mortality for patients with intracerebral hematoma treated by craniotomy and hematoma evacuation.
Methods: An observational, prospective study of 116 patients with intracerebral hematoma treated surgically was carried out. Preoperative factors related to postoperative mortality were identified. The identified prognostic factors were combined in an index to estimate its predictive capacity, and this capacity was verified in a different sample.
Results: Age ≥ 60 years, Glasgow Coma Scale score ≤ 10 points, and hematoma depth ≥ 1.25 cm are independent predictors of postoperative mortality. The area under the curve for the probability of dying calculated by the logistic regression model in the estimation sample was 0.953 (CI: 0.905-1.000). The proposed postoperative mortality prognostic index classifies patients as low, intermediate, high risk and very high risk of death.
Conclusions: The proposed prognostic index correctly predicts postoperative mortality in patients with intracerebral hematoma treated by craniotomy and evacuation of the hematoma.
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References
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18. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH Score. A simple, reliable Grading Scale for Intracerebral Hemorrhage. Stroke. 2001; 32(4):891-7. DOI: 10.1161/01.str.32.4.891
19. Gregorio T, Pipa S, Cavaleiro P, Atanasio G, Albuquerque I, Castro P, et al. Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis. Neurocrit Care. 2019; 30(2):449-66. DOI: 10.1007/s12028-018-0633-6
20. Zyck S, Du L, Gould G, Latorre JG, Beutler T, Bodman A, Krishnamurthy S. Scoping review and commentary on prognostication for patients with intracerebral hemorrhage with advances in surgical techniques. Neurocrit Care. 2020; 33(1):256-72. DOI: 10.1007/s12028-020-00962-y
21. Fahlström A, Nittby H , Zeberg H, Bartek J Jr , Bartley A, Tobieson L, et al. A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score. J Neurosurg. 2019;1-8. DOI: 10.3171/2019.5.JNS19622
22. Haga JA, Poulsen FR, Forsse A. Validation of the newly conceived Surgical Swedish ICH grading scale for surgically treated patients with intracerebral hemorrhage: patient series. J Neurosurg Case Lessons. 2021; 1(1):CASE2044-9. DOI: 10.3171/CASE2044
23. Hong S, Maruyama K, Noguchi A, Hirano T, Nagane M, Shiokawa Y. Is using intracerebral hemorrhage scoring systems valid for mortality prediction in surgically treated patients? Neurosurg Rev. 2021; 44(5):2747-53. DOI: 10.1007/s10143-020-01451-8
2. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2022; 53(7):e282-e361. DOI: 10.1161/STR.0000000000000407
3. Ministerio de Salud Pública. Anuario estadístico de salud 2020. La Habana: Dirección de Registros Médicos y Estadísticas de Salud (DNE); 2021. Disponible en: http://bvscuba.sld.cu/anuario-estadisticode-cuba/
4. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013; 382(9890):397-408. DOI: 10.1016/S0140-6736(13)60986-1
5. Scaggiante J, Zhang X, Mocco J, Kellner CP. Minimally Invasive Surgery for Intracerebral Hemorrhage. An Updated Meta-Analysis of Randomized Controlled Trials. Stroke. 2018; 49(11):2612-20. DOI: 10.1161/STROKEAHA.118.020688
6. Zheng J, Li H, Zhao HX, Guo R, Lin S, Dong W, et al. Surgery for Patients With Spontaneous Deep Supratentorial Intracerebral Hemorrhage: A Retrospective Case-Control Study Using Propensity Score Matching. Medicine. 2016; 95(11):e3024. DOI: 10.1097/MD.0000000000003024
7. Kobata H, Ikeda N. Recent Updates in Neurosurgical Interventions for Spontaneous Intracerebral Hemorrhage: Minimally Invasive Surgery to Improve Surgical Performance. Front Neurol. 2021; 12:703189. DOI: 10.3389/fneur.2021.703189
8. Sánchez ME. Factores pronósticos de mortalidad posoperatoria por hematoma intracerebral espontáneo. AHCG. 2019 [acceso: 12/05/2022]; 7(3): [aprox. 12 p.]. Disponible en: http://www.revcalixto.sld.cu/index.php/ahcg/article/view/407
9. Sánchez ME, Verdial R, Menéndez DM, Barbosa A, Manfugás G, Domínguez A. Protocolo de actuación médica para el tratamiento quirúrgico del hematoma intracerebral espontáneo. AHCG. 2020 [acceso: 12/05/2022]; 8(1):[aprox. 16 p.]. Disponible en: http://www.revcalixto.sld.cu/index.php/ahcg/article/view/457/411
10. Carpenter AB, Lara-Reyna J, Hardigan T, Ladner T, Kellner C, Yaeger K. Use of emerging technologies to enhance the treatment paradigm for spontaneous intraventricular hemorrhage. Neurosurg Rev. 2021; 45(1):317-28. DOI: 10.1007/s10143-021-01616-z
11. Kothari RU, Brott T, Broderick JP, BarsanWG, Sauerbeck LR, Zuccarello M, Khoury J. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996; 27(8):1304-5. DOI: 10.1161/01.str.27.8.1304
12. Cerda J, Cifuentes L. Usos de curvas ROC en investigación clínica. Aspectos teórico-prácticos. Rev Chil Infect. 2012; 29(2):138-41. DOI:10.4067/S0716-10182012000200003
13. Suárez A, Álvarez A, López E, Bárzaga S, Santisteban A. Pronóstico de muerte en pacientes con hemorragia intracerebral supratentorial espontánea. Revista Finlay. 2016 [acceso: 29/05/2022]; 2016;6(1):32-40. Disponible en: http://www.revfinlay.sld.cu/index.php/finlay/article/view/408
14. Aguilera OR, González D. Factores pronósticos en la hemorragia cerebral intraparenquimatosa. MEDISAN. 2012 [acceso: 29/05/2022]; 16(1):21-8. Disponible en: http://scielo.sld.cu/pdf/san/v16n1/san03112.pdf
15. Rodríguez LA. Indicadores morfométricos predictores de mortalidad en pacientes con hemorragias intracerebrales lobares espontaneas. MEDICIEGO. 2016 [acceso: 29/05/2022]; 22(3):37-42. Disponible en: http://www.revmediciego.sld.cu/index.php/mediciego/article/view/512/1010
16. Pérez AR, García A, Sosa EF, Padrón F. Factores pronósticos de mortalidad por hemorragia intracerebral en el periodo agudo. Rev Cub Med Mil. 2015 [acceso: 29/05/2022]; 44(3):277-88. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=64146
17. Kumar AA, Valson JS. Surgery in Spontaneous Intracerebral Hemorrhage- A Series Analysis. J Neurol Stroke. 2015; 2(4):60-71. DOI: 10.15406/jnsk.2015.02.00060
18. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH Score. A simple, reliable Grading Scale for Intracerebral Hemorrhage. Stroke. 2001; 32(4):891-7. DOI: 10.1161/01.str.32.4.891
19. Gregorio T, Pipa S, Cavaleiro P, Atanasio G, Albuquerque I, Castro P, et al. Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis. Neurocrit Care. 2019; 30(2):449-66. DOI: 10.1007/s12028-018-0633-6
20. Zyck S, Du L, Gould G, Latorre JG, Beutler T, Bodman A, Krishnamurthy S. Scoping review and commentary on prognostication for patients with intracerebral hemorrhage with advances in surgical techniques. Neurocrit Care. 2020; 33(1):256-72. DOI: 10.1007/s12028-020-00962-y
21. Fahlström A, Nittby H , Zeberg H, Bartek J Jr , Bartley A, Tobieson L, et al. A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score. J Neurosurg. 2019;1-8. DOI: 10.3171/2019.5.JNS19622
22. Haga JA, Poulsen FR, Forsse A. Validation of the newly conceived Surgical Swedish ICH grading scale for surgically treated patients with intracerebral hemorrhage: patient series. J Neurosurg Case Lessons. 2021; 1(1):CASE2044-9. DOI: 10.3171/CASE2044
23. Hong S, Maruyama K, Noguchi A, Hirano T, Nagane M, Shiokawa Y. Is using intracerebral hemorrhage scoring systems valid for mortality prediction in surgically treated patients? Neurosurg Rev. 2021; 44(5):2747-53. DOI: 10.1007/s10143-020-01451-8
Published
2022-09-26
How to Cite
1.
Sánchez Padín ME, Peguero Garó JA, Solomon Cardona MT, Viada González CE. Prognostic index of postoperative mortality for patients with primary intracerebral hemorrhage. Rev Cubana Med Milit [Internet]. 2022 Sep. 26 [cited 2025 Apr. 10];51(4):e02202170. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2170
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