The Diagnostic Utility of ICH-Score in Patients with Anticoagulant Related Intracerebral Hemorrhage
Katsanos Ph A, Krogias C, Lioutas VA, Goyal N, Zand R, Sharma V, Panayiotis V, Malhotra K, Paciaroni M, Sharaf A, Chang J, Karapanayiotides T, Kargiotis O, Pappa A, Mai J, Tsantes A, Mitsias P, Selim M, Alexandrov A, and Tsivgoulis G. The Diagnostic Utility of ICH-Score in Patients with Anticoagulant Related Intracerebral Hemorrhage. Eur Stroke J 2019; 4:458.
Eur Stroke J
Background and Aims: Intracerebral hemorrhage (ICH) score presents a prognostic model of mortality among patients with spontaneous ICH of any cause, which has not been validated in patients with oral anticoagulant related ICH (OAC-ICH).We performed a post-hoc analysis of two prospective cohorts to estimate the diagnostic performance of ICH score in OAC-ICH related to the use of vitamin K antagonists (VKAICH) or non-vitamin K oral anticoagulants (NOAC-ICH). Methods: We identified the diagnostic accuracy and optimal cut-off in ICH score for the prognostication of 30-day mortality between NOACICH and VKA-ICH patients with receiver operating characteristic (ROC) curve analysis. Results: We included 108 NOAC-ICH and 241 VKA-ICH patients [mean age:74±10 years, 58% men, median NIHSS score:11 (4-21), median ICH-score:2 (1-3)]. A cut-off of 4 points in the ICH score was highlighted as the optimal threshold for the prognostication of 30-day mortality [sensitivity:57.7%, specificity:98.8% for NOAC-ICH; sensitivity: 42.1%, specificity:92.6% for VKA-ICH]. Overall, the predictive value of ICH-score was higher (p=0.001) in NOAC-ICH (AUC: 0.92, 95%CI: 0.86-0.98) compared to VKA-ICH (AUC: 0.77, 95%CI: 0.70-0.83; Figure). Conclusions: ICH score has satisfactory predictive value in the prognostication of 30-day mortality for OAC-ICH. The diagnostic yield of the score appears to be higher in NOAC-ICH than in VKA-ICH.