Abstract 3792: The Modified Graeb-scale Evaluates Extent Of Ventricular Hemorrhage And Independently Predicts Functional Outcome After Intracerebral Hemorrhage In A Population-based Cohort
Introduction: Presence of intraventricular hemorrhage (IVH) reduces survival probability after intracerebral hemorrhage (ICH). A new semi-quantitative method, describing the extent of IVH, the modified-Graeb-scale (mGraeb), has been developed for clinical trial use (e.g. CLEAR IVH). It ranges from 0 when no IVH is present, to 32 when all ventricles are filled and also expanded by blood. We analyzed the predictive value of mGraeb in a population-based ICH cohort.
Method: We included 256 consecutive first-ever stroke patients with ICH from Lund Stroke Register. Baseline CT scans (< 7 days after ICH) were analysed by two independent readers evaluating mGraeb, ICH-location (deep, lobar, mixed, infra-tentorial) and ICH-volume. Baseline Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) at 3 months were estimated from patient files. Cox proportional hazards models were used to identify predictive factors (age, sex, GCS and ICH-volume in all models; IVH / mGraeb and supratentorial ICH / all ICH in different models) for unfavourable outcome defined as mRS>3 or death at 3 months.
Results: IVH was detected in 116 (45%) of 256 patients, with a mean mGraeb of 11.2 (range 1-28). At 3 months, the 161 (63%) patients who were still alive had a mean mRS of 2.7. In the primary Cox analysis of patients with supratentorial ICH (n=206), the presence of IVH more than doubled the hazard for poor outcome (HR 2.20; 95% CI 1.42-3.40; p<0.001). In the secondary Cox analysis, each unit increase in mGraeb increased the hazard by 6% (HR 1.06; 95% CI 1.03-1.09; p<0.001). Age (HR 1.03; 95% CI 1.02-1.05; p<0.001), GCS (HR 1.42; 95% CI 1.23-1.65; p<0.001) and ICH-volume (HR 1.07; 95% CI 1.03-1.11; p=0.001) were also related to poor outcome. Sex and ICH-location did not independently influence the outcome in the secondary Cox analysis. Results where similar when the endpoint was changed to death at 3 months and also when cases with infratentorial ICH (n=50) were included in a tertiary Cox analysis.
Conclusion: The mGraeb, is an independent predictor for outcome after ICH. Compared with the dichotomous variable IVH (yes/no), it gives more detailed information regarding prognosis. The mGraeb can be considered for routine evaluation of ICH patient prognosis.
- © 2012 by American Heart Association, Inc.