Comparison of Prognostic Models of Spontaneous Intracerebral Hemorrhage: Potential Tools for Personalized Care and Clinical Trial in ICH

Abstract Background: Several prognostic models have been developed for spontaneous intracerebral hemorrhage (ICH); however, none of them have been consistently used in routine clinical practice or clinical research. In the study, we systematically compared 27 ICH models with regard to mortality and functional outcome at 1-month, 3-month and 1-year after ICH. Methods: The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1-month, 3-month and 1-year after ICH, respectively. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. Moderate, good, excellent and outstanding discrimination were predefined as AUROC of 0.75-0.79, 0.80-0.84, 0.85-0.89 and above 0.90, respectively.Results: A total number of 1575 patients were included. The mean age was 57.2±14.3 and 67.2% were male. The median NIHSS score on admission was 11 (IQR: 3-21). For predicting mortality at 3-month after ICH, AUROC of 27 ICH models ranged from 0.604 to 0.856. One model showed excellent discrimination; fifteen models demonstrated good discrimination; and seven models demonstrated moderate discrimination. In pairwise comparison, the ICH-FOS (0.856, 95%CI=0.835-0.878, P<0.001) showed statistically better discrimination than other models for mortality at 3-month after ICH (all P<0.05). For predicting poor functional outcome (mRS≥3) at 3-month after ICH, AUROC of 27 ICH models ranged from 0.602 to 0.880. Five models showed excellent discrimination; six models demonstrated good discrimination; and ten models demonstrated moderate discrimination. In pairwise comparison with other prediction models, the ICH-FOS was superior in predicting poor functional outcome at 3-month after ICH (all P<0.001). Several risk models were well calibrated (Hosmer-Lemeshow test P>0.05) for mortality and poor functional outcome at 3-month after ICH, however, the ICH-FOS showed the largest Cox and Snell R-square. Similar results were verified for mortality and poor functional outcome at 1-month and 1-year after ICH. Conclusion: Several risk models are externally validated to be effective for risk stratification and outcome prediction after ICH, especially the ICH-FOS, which would be useful tools for personalized care and clinical trial in ICH.