• Koushik Pan, Ajay Panwar, Ujjawal Roy, and Bidyut K Das.
• Department of Neurology, Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, India.
• J Stroke Cerebrovasc Dis. 2017 Nov 1; 26 (11): 2563-2569.

BackgroundThe intracerebral hemorrhage (ICH) score is well established as a reliable prognostic score in ICH, whereas recently, Acute Physiology and Chronic Health Evaluation II (APACHE II) has been observed to have a better discrimination in predicting mortality in primary pontine hemorrhage. Further, physiological parameters of APACHE II have been associated with outcome in ICH. This study is the first to observe a direct comparison between APACHE II and ICH scores in predicting 30-day mortality in spontaneous intracerebral hemorrhage (SICH).Materials And MethodsThis study was a prospective observational study where we compared the receiver operating characteristic (ROCs) of baseline ICH and APACHE II scores in patients with SICH for predicting 30-day mortality outcome.ResultsWe observed that both APACHE II and ICH scores were good for predicting 30-day mortality with both having an area under the ROC curve of more than .8 (.831 [95% confidence interval {CI}, .740-.922; P <.001] and .892 [95% CI, .757-.932; P <.001], respectively). However, the ICH score was better discriminative (area under the curve AUC, .892 versus .831; P = .040) and better calibrated (P = .037 versus P = .089, Hosmer-Lemeshow goodness-of-fit test for logistic regression) for the same. Both APACHE II and ICH scores had a sensitivity of 87% at cutoff values of 19 and 3, respectively; however, the ICH score had a better specificity (90% versus 76.5%).ConclusionThe ICH score was observed to have a better discrimination and calibration for predicting 30-day mortality in SICH.Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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