Predicting the outcome of surgically treated patients with spontaneous intracerebral hemorrhage: a multicenter retrospective study

Abstract

Abstract Background and Purpose: Spontaneous intracerebral hemorrhage (ICH) is the deadliest type of stroke, and surgery is still one of the main treatment options for ICH. The aim of this study was to establish a prognostic model for surgically treated ICH patients. Methods: Data for this study were drawn from a national multicenter observational cohort study (ClinicalTrials identifier NCT03862729). Poor outcome was defined as modified Rankin Scale ≥ 4 at discharge. Overall survival (OS) was defined as the time from surgery to death or last follow-up. Multivariate logistic regression analysis was performed to identify significant variables associated with poor outcome. Associations of the variables with OS were assessed by Cox proportional hazard regression models. Prognostic scores were developed based on the regression coefficients. Receiver operating characteristic (ROC) curve analyses and the area under the ROC curve (AUC) were used to assess the predictive value of the model. Subgroup analyses were performed by splitting centers to assess the applicability of the two models. Results: Out of 1164 patients in the database, a total of 182 patients who met the inclusion criteria were included in this study. Preoperative Glasgow Coma Scale (GCS), deep ICH and presence of intraventricular hemorrhage were independent predictors of poor outcome. Age, preoperative GCS, presence of hydrocephalus and postoperative re-hemorrhage were independently associated with OS. Based on the results, two risk score models were established. The AUC of poor outcome risk (POR) score was 0.850 (95% CI 0.782 - 0.918) and the cut-off value was -0.982. 93.7% of patients identified as high-risk group had poor outcomes. The C-index of overall survival risk (OSR) score was 0.802 (95% CI 0.748-0.856). The Kaplan-Meier survival curves showed significantly (P < 0.001) lower survival probability in the high-risk group. Subgroup analyses showed no significant change in C-index and AUC values between groups. Conclusions: Our study proposed two new prognostic models for surgically treated ICH patients.