TY - JOUR
T1 - Scoring system to predict hospital outcome after subarachnoid hemorrhage–incorporating systemic response
T2 - The CRIG score
AU - Hathidara, Mausaminben Y.
AU - Campos, Yesica
AU - Chandrashekhar, Swathy
AU - Xu, Chao
AU - Olson, Dai Wai M.
AU - Venkatachalam, Aardhra
AU - Ray, Bappaditya
N1 - Funding Information:
The author(s) would like to acknowledge Dr. David M Thompson, PhD for critically reviewing the manuscript and contribution of research assistant, Ms. Blair Apple, BS with Department of Neurology, OUHSC for their help with data management during the study. In addition, contribution of Ms. Kelsey Marble, data scientist at UT Southwestern Medical Center for data extraction from electronic medical records.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/8
Y1 - 2022/8
N2 - 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.
AB - 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.
KW - Hemorrhagic stroke
KW - Inflammatory response
KW - Peripheral blood indices
KW - Scoring system
UR - http://www.scopus.com/inward/record.url?scp=85130566979&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130566979&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2022.106577
DO - 10.1016/j.jstrokecerebrovasdis.2022.106577
M3 - Article
C2 - 35623237
AN - SCOPUS:85130566979
SN - 1052-3057
VL - 31
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 8
M1 - 106577
ER -