DETERMINACIÓN DE VARIABLES PRONÓSTICAS DE MORTALIDAD Y RECUPERACIÓN FUNCIONAL EN HEMORRAGIA INTRACEREBRAL ESPONTÁNEA

Abstract

Background and aim: Spontaneous intracerebral hemorrhage (ICH) is a type of stroke associated with high mortality, morbidity, and economic impact. Currently, there are no effective treatments to improve the prognosis of ICH. Early implementation of supportive and neurocritical care measures plays a crucial role in patient survival. However, these interventions may result in functional disability for many patients. Previous attempts to define prognostic factors and develop prognostic scales for ICH have been met with skepticism. Some studies question their relevance in contemporary neurocritical care due to overestimated mortality rates, low reliability in predicting functional outcomes, and the potential for self-fulfilling prophecy bias. The main objective of this doctoral thesis is to create an accurate and easily applicable scale to predict the functional recovery prognosis of maximally treated ICH patients._x000D_ _x000D_ Material and methods: A prospective observational multicenter cohort study. Inclusion criteria were adult patients with a functional status of mRS≤3 (modified Rankin Scale) diagnosed with spontaneous ICH within 24 hours of symptom onset. Baseline variables (epidemiological, clinical, analytical, and radiological) and outcome variables were collected. The primary endpoint was assessed using the mRS scale at 90 days, with a favorable prognosis defined as mRS≤3. Thes variables were used to construct candidate scales using logistic regression and decision tree-based algorithms (Random Forest)._x000D_ _x000D_ Results: The study included 250 patients in the design cohort, of whom 218 (87.2%) received maximum treatment. Out of these, 95 (43.6%) patients achieved a good functional prognosis at 3 months, while 75 (34.4%) patients died. Baseline variables associated with functional prognosis were identified, including NIHSS, age, ICH volume, platelets, time from symptom onset to hospital arrival, lobar location, leukocytes, CRP (C-reactive protein), and hematocrit. After evaluating different categorizations and numbers of variables, a new prognostic scale (Scale 5) was derived. Scale 5 consisted of four items: NIHSS, age, ICH volume, and time from symptom onset to hospital arrival. Each item was assigned a certain number of points based on specific ranges or thresholds. Scale 5 demonstrated high discrimination and predictive accuracy for functional prognosis, mortality, and severe dependence at 90 days. It outperformed previously known scales such as oICH, ICH-GS, and FUNC score, and performed similarly to mICH. However, its prognostic capacity was lower than Max-ICH in the validation cohort._x000D_ _x000D_ Conclusion: This doctoral thesis successfully developed a new, easy-to-use scale with high discrimination and accuracy in predicting functional recovery prognosis in maximally treated patients with intracerebral hemorrhage. The scale, known as Scale 5, combines four variables and shows promising results in determining functional outcomes.

Date of Award	27 Oct 2023
Original language	Spanish
Supervisor	Monica Millan Torne (Director) & Pilar Ricart Marti (Director)