J Clin Neurol.  2015 Oct;11(4):339-348. 10.3988/jcn.2015.11.4.339.

Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis

• Mattishent K
• Kwok CS
• Ashkir L
• Pelpola K
• Myint PK
• Loke YK

• KMID: 2179753
• DOI: http://doi.org/10.3988/jcn.2015.11.4.339

Abstract

BACKGROUND AND PURPOSE
Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools.
METHODS
We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data.
RESULTS
We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).
CONCLUSIONS
Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

Keyword

stroke; prognostic scores; risk prediction model; mortality

MeSH Terms

Area Under Curve
Cerebral Hemorrhage
Cohort Studies
Discrimination (Psychology)
Mortality*
Prospective Studies
Retrospective Studies
ROC Curve
Stroke*

Figure

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  Fig. 1 Flow chart of study selection. AUC: area under receiver operating characteristic curve.

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  Fig. 2 Meta-analysis of the areas under the receiver operating characteristic curve (AUC) for various prognostic models. CI: confidence interval, ICH: intracerebral hemorrhage.

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  Fig. 3 Subgroup analyses of the Hemphill-intracerebral hemorrhage model according to the study design and characteristics of participants. CI: confidence interval.

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