Scoring system to predict hospital outcome after subarachnoid hemorrhage–incorporating systemic response: The CRIG score

Mausaminben Y. Hathidara, Yesica Campos, Swathy Chandrashekhar, Chao Xu, Dai Wai M. Olson, Aardhra Venkatachalam, Bappaditya Ray

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Local and systemic proinflammatory and prothrombotic processes after aneurysmal subarachnoid hemorrhage (aSAH) precipitate delayed cerebral ischemia (DCI) and determine clinical outcome. Recent studies using admission and temporal trends of mean platelet volume to platelet count ratio (MPV:PLT) and neutrophil to lymphocyte ratio (NLR) have identified patients developing DCI. We examine if MPV:PLT and NLR along with admission clinical or radiological features can be used to develop a scoring system to predict DCI and in-hospital clinical outcome. Materials and methods: A 7-year retrospective cohort of aSAH patients admitted to a tertiary care medical center was used to study and identify clinical, radiological and laboratory parameters to predict DCI and clinical outcome (good: discharge to home or rehabilitation facility; poor: all other discharge destinations). Using regression analyses a scoring system (Clinical, Radiological, Inflammatory, dysGlycemia, CRIG) was developed. Results: Of 271 patients, admission clinical grade (World Federation of Neurological Surgeons’ scale), radiological grade (modified Fisher score), NLR and glycated hemoglobin were identified as contributors for CRIG score. CRIGDCI score threshold of 112 and CRIGdischarge 109, respectively predicted DCI and adverse clinical outcome in score development cohort. The same threshold predicted DCI and adverse clinical outcome with 78.1 and 100% sensitivity, 44.0 and 52.2% specificity, and 63.2 and 61.4% accuracy, respectively in the score validation cohort. Conclusions: CRIG is an easily calculable scoring system that incorporates systemic response of aSAH – thus, alluding to its multisystem nature. It can be used at the time of admission to predict DCI and clinical outcome.

Original languageEnglish (US)
Article number106577
JournalJournal of Stroke and Cerebrovascular Diseases
Volume31
Issue number8
DOIs
StatePublished - Aug 2022
Externally publishedYes

Keywords

  • Hemorrhagic stroke
  • Inflammatory response
  • Peripheral blood indices
  • Scoring system

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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