急诊脑出血分级量表对脑出血患者不良预后的预测价值

Predictive value of emergency intracerebral hemorrhage grading scale for adverse prognosis in patients with intracerebral hemorrhage

目的研究急诊脑出血分级量表(emergency department intracerebral hemorrhage grading scale,EDICH)评分和改良急诊脑出血分级量表(modified emergency department intracerebral hemorrhage grading scale,mEDICH)评分对脑出血患者出院90 d后不良预后的预测价值。方法回顾性分析2022年1-12月在徐州医科大学附属连云港医院神经外科就诊的248例脑出血患者临床资料,根据出院90 d后改良Rankin评分(modified Rankin scale,mRS)分为预后好组(212例)和预后差组(36例),采用两组独立样本t检验和秩和检验比较两组患者的基本资料、入院生命体征、实验室检查、影像学特征、EDICH评分和mEDICH评分等,使用多因素Logistic回归分析影响脑出血患者预后不良的危险因素;绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析EDICH评分和mEDICH评分对脑出血患者出院90 d后不良预后的预测价值。结果预后差组的脑血肿直径[(5.53±0.32)cm]、发生脑室出血比率(61.11%,22/36)和幕下出血比率(27.78%,10/36)高于预后好组[(3.50±0.07)cm、(30.19%,64/212)和(14.15%,30/212)],差异均有统计学意义(统计量值分别为t=6.19、χ^(2)=12.99、χ^(2)=4.22,P值分别为<0.001、<0.001、0.040),预后差组的入院GCS评分低于预后好组(H=72.01,P<0.001),预后差组的EDICH评分和mEDICH评分均高于预后好组(EDICH评分:H=65.79,P<0.001;mEDICH评分:H=76.56,P<0.001);多因素Logistic回归分析显示EDICH评分(OR=5.869,95%CI 3.451~9.981,P<0.05)和mEDICH评分(OR=10.353,95%CI 4.842~22.137,P<0.05)可预测脑出血患者出院90 d后预后;ROC曲线分析显示,EDICH评分与mEDICH评分灵敏度分别为0.861、0.889,特异度分别为0.821、0.953,但mEDICH评分预测效果明显优于EDICH评分(Kappa值分别为0.787、0.494),其预测结果与实际结果具有高度一致性。结论mEDICH评分能准确预测脑出血患者出院90 d后的预后,具有临床应用价值。

Objective To study the emergency cerebral hemorrhage grading scale(EDICH)score and the modified emergency intracerebral hemorrhage grading scale(mEDICH)score on the adverse prognosis of patients with cerebral hemorrhage 90 days after discharge.Methods The clinical data of 248 patients with cerebral hemorrhage in the Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2022 to December 2022 were retrospectively analyzed.According to the modified Rankin scale(mRS)90 days after discharge,patients were divided into a good prognosis group(212 cases)and a poor prognosis group(36 cases).Independent-samples t-test and rank-sum test were used to compare the basic information,vital signs,laboratory tests,imaging characteristics,EDICH score and mEDICH score of the two groups.Multivariate Logistic regression was used to analyze the risk factors affecting the poor prognosis of patients with cerebral hemorrhage.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of EDICH score and mEDICH score for the poor prognosis of patients with intracerebral hemorrhage 90 days after discharge.Results The diameter of intracerebral hematoma(5.53±0.32)cm,the rate of intraventricular hemorrhage(61.11%,22/36)and the rate of subtentorial hemorrhage(27.78%,10/36)in poor prognosis group were significantly higher than those in good prognosis group(3.50±0.07)cm,intraventricular hemorrhage(30.19%,64/212)and infratentorial hemorrhage(14.15%,30/212),the differences were statistically significant(t=6.19,P<0.001;χ^(2)=12.99,P<0.001;χ^(2)=4.22,P=0.040).GCS scores in the poor prognosis group were lower than those in the good prognosis group(H=72.01,P<0.001).EDICH scores and mEDICH scores in the poor prognosis group were higher than those in the good prognosis group(EDICH score:H=65.79,P<0.001;mEDICH score:H=76.56,P<0.001).Multivariate Logistic regression analysis showed EDICH score(OR=5.869,95%CI 3.451-9.981,P<0.05)and mEDICH score(OR=10.353,95%CI 4.842-22.137,P<0.05)could predict the prognosis of patients with cerebral hemorrhage 90 days after discharge.ROC curve analysis showed that the sensitivity and specificity of EDICH score and mEDICH score were 0.861,0.889 and 0.821,0.953,respectively,but the predictive effect of mEDICH score was significantly better than that of EDICH score(Kappa values were 0.787 and 0.494,respectively).The predicted results are highly consistent with the actual results.Conclusion MEDICH score can accurately predict the prognosis of patients with intracerebral hemorrhage 90 days after discharge,which has clinical application value.