Abstract：【Objective】 To explore the predictive value of intracerebral hemorrhage score combined with acute physiology and chronic health score Ⅱ (APACHE Ⅱ) in predicting the prognosis of patients with spontaneous intracerebral hemorrhage (SICH). 【Methods】 Forty-two patients with SICH admitted from November 2015 to December 2018 were selected as subjects. The cerebral hemorrhage score was evaluated at admission, APACHE Ⅱ score was evaluated within 24 hours of admission, and the modified Rankin scale (MRS) score was evaluated at 1 month of onset,poor prognosis was defined as MRS ≥ 4. The prognostic value of cerebral hemorrhage score and APACHE Ⅱ score alone and in combination was evaluated. 【Results】 According to MRS score, 19 cases (45.24%) had poor prognosis and 23 cases (54.76%) had good prognosis. The scores of cerebral hemorrhage and APACHE Ⅱ in poor prognosis group were significantly higher than those in the good prognosis group (P<0.05). The area under ROC curve of cerebral hemorrhage score and APACHE Ⅱ score predicting poor prognosis was 0.841 (95% CI = 0.724~0.958, P<0.001), 0.817 (95% CI = 0.690~0.944, P<0.001), respectively. The combined scheme had the highest specificity, positive predictive value and predictive accuracy, while the single scheme had higher sensitivity and negative predictive value, but the prediction accuracy was the worst.【Conclusion】 Both intracerebral hemorrhage score ≥ 2 and APACHE Ⅱ score ≥ 19 points have good value in predicting the adverse prognosis of SICH patients. Serial connection can improve the predictive specificity, positive predictive value and predictive accuracy.
[1] Wang W, Jiang B, Sun H,et al. Prevalence, incidence, and mortality of stroke in china: results from a nationwide population-based survey of 480~687 adults[J].Circulation,2017, 135(8): 759-771. [2] 张运周,高冉,高岱佺,等.改良急诊脑出血分级量表对自发性脑出血患者30天病死率的预测作用[J].中华老年心脑血管病杂志,2016,18(6):564-566. [3] Hemphill JC,Bonovich DC, Besmertis L, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage[J].Stroke,2001, 32(4): 891-897. [4] Pan K, Panwar A, Roy U, et al. A comparison of the intracerebral hemorrhage score and the acute physiology and chronic health evaluation ii score for 30-day mortality prediction in spontaneous intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2017, 26(11): 2563-2569. [5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444. [6] Reith FC, Van den Brande R, Synnot A, et al. The reliability of the glasgow coma scale: a systematic review[J].Intensive Care Med,2016, 42(1): 3-15. [7] Broderick JP, Adeoye O, Elm J. Evolution of the modified rankin scale and its use in future stroke trials[J].Stroke,2017, 48(7): 2007-2012. [8] 李诗雨,吴世政,才鼎,等.CT血管造影点征在早期脑出血患者的临床意义及应用价值[J].中华老年心脑血管病杂志,2017,19(1):103-105. [9] 万宏,马树海,柴迎春,等.Hemphill脑出血评分量表在预测自发性脑出血患者死亡中的作用[J].中国临床神经外科杂志,2009,14(10):629-631. [10] Ferrete-Araujo AM, Egea-Guerrero JJ, Vilches-Arenas ,et al. Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: a prospective observational study[J].Med Intensiva,2015, 39(7): 422-432. [11] Suo Y, Chen WQ, Pan YS, et al. The max-intracerebral hemorrhage score predicts long-term outcome of intracerebral hemorrhage[J].CNS Neurosci Ther,2018, 24(12): 1149-1155.
2019, Vol. 36 
