Neurology: Cerebral small vessel disease, which can exacerbate the poor prognosis of patients with intracerebral hemorrhage

Spontaneous (non-traumatic) intracerebral hemorrhage (ICH) is a stroke with a poor clinical prognosis, with a mortality rate of 40% within 30 days and a mortality rate of 65% within 1 year.
Only 20% of survivors achieved functional independence at 6 months.
In order to plan clinical care and provide prognostic information, it is necessary to understand which baseline factors are associated with functional outcomes in the acute phase.

Some clinical-radiological scores have been developed to predict functional outcome or mortality at different time points (usually 30 or 90 days) after ICH.
Subsequent studies verified the different results of the existing scores at different time points.
The ICH score (0-6 points scale) is the most commonly used and widely validated predictive score.

The ICH score consists of 5 parts: Glasgow Coma Scale (GCS) 3-4 points (corresponding to ICH 2 points); GCS assessment 5-12 points (corresponding to IHC 1 point), age ≥ 80 years old (corresponding to ICH1 point) , Submeningeal area (1 point), ICH volume ≥ 30 ml (1 point), and intraventricular hemorrhage (1 point).

Cerebral small vascular disease (SVD) includes deep perforation (hypertension) arterial disease and cerebral amyloid vascular disease, which are considered to be the extreme cases of continuous age-related disease.
SVD causes 77% of spontaneous ICH, which can be easily assessed with neuroimaging markers from MRI and CT scans, and is related to the functional outcome and cognitive decline after stroke.
It is not yet known whether the burden of SVD can improve the predictive performance of existing clinical-radiological scores for functional outcomes after ICH.

It is not yet known whether the burden of SVD can improve the predictive performance of existing clinical-radiological scores for functional outcomes after ICH.
It is not yet known whether the burden of SVD can improve the predictive performance of existing clinical-radiological scores for functional outcomes after ICH.

In this way, Isabel C.
Hostettler and others of UCL, based on a large multicenter ICH cohort in the United Kingdom, explored the relationship between CT-based SVD biomarkers and 6-month functional outcome, and assessed whether they can improve the ICH score Predictive performance.

They included 864 patients with acute ICH.
We evaluated CT-based SVD biomarkers (white matter hypodensity, fissures, brain atrophy, and SVD burden composite score) and their relationship with the 6-month adverse functional outcome (modified Rankin scale score> 2 )Relationship.
The area under the ROC curve and the Hosmer-Lemeshow test were used to assess the discrimination and calibration of ICH scores with and without SVD biomarkers.

They found that the presence of WMH (OR=1.
52), the presence of cortical atrophy (OR 1.
80), the presence of deep atrophy (OR 1.
66), and severe atrophy (deep or cortical) (OR 1.
94) were independently associated with adverse functional outcomes .

The presence of WMH (OR=1.
52), the presence of cortical atrophy (OR 1.
80), the presence of deep atrophy (OR 1.
66), and severe atrophy (deep or cortical) (OR 1.
94) are independently associated with adverse functional outcomes .
The presence of WMH (OR= 1.
52), the presence of cortical atrophy (OR 1.
80), the presence of deep atrophy (OR 1.
66) and severe atrophy (deep or cortical) (OR 1.
94) are independently associated with adverse functional outcomes

For the revised ICH score, the area under the ROC curve is 0.
71 (95% CI 0.
68-0.
74).
The addition of SVD markers did not significantly improve the discriminative ability of the ICH score; for the best model (added severe atrophy), the area under the ROC curve was 0.
73 (95% CI 0.
69-0.
76).
These results were confirmed when large-leaf and non-large-leaf ICH were considered separately.

The important significance of this study is that it is found that the ICH score has a good resolution for predicting the functional outcome 6 months after ICH .
The CT biomarkers of SVD are related to the functional outcome, but adding these markers does not significantly improve the resolution of the ICH score.
The original source is neurology.

org/content/96/15/e1954" target="_blank" rel="noopener">Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage

Found that the ICH score has a good resolution for predicting functional results 6 months after ICH.

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