Prediction of functional outcome in patients with primary intracerebral hemorrhage the FUNC score
Prediction of functional outcome in patients with primary intracerebral hemorrhage the FUNC score
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DOI：
10.1161/strokeaha.107.512202
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发表时间：
2008-08-01
期刊：
影响因子：
8.3
通讯作者：
Rosand, Jonathan
中科院分区：
文献类型：
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作者：
Rost, Natalia S.;Smith, Eric E.;Rosand, Jonathan
背景和目的 - 脑出血 (ICH) 是最致命和致残的中风亚型。广泛使用的死亡率预测工具从根本上是有限的，因为它们没有考虑停止护理的影响，也不是为了预测功能恢复而设计的。我们开发了急性临床评分来预测功能独立的可能性。方法 - 我们前瞻性地对 629 名在医院就诊的连续 ICH 患者进行了特征分析。 90 天时功能独立的预测因子（格拉斯哥结果评分 >= 4）用于在三分之二的随机子集中制定基于逻辑回归的风险分层量表，并在剩余三分之一的队列中进行验证。结果 - 在 90 天时，162 名 (26%) 患者实现了独立。年龄、格拉斯哥昏迷量表、ICH 位置、体积（所有 P < 0.0001）和 ICH 前认知障碍（P = 0.005）与格拉斯哥结果评分 >= 4 独立相关。FUNC 评分根据与结果的关联强度开发为各个分数 (0-11) 的总和。在开发和验证队列中，达到格拉斯哥结果评分 >= 4 的患者比例随着 FUNC 评分的增加而稳步增加。没有患者的 FUNC 评分达到 80%（得分为 11）。当仅限于 ICH 幸存者时，FUNC 评分的预测准确性保持不变，这与不存在因早期退出护理而造成的混淆一致。结论 - FUNC 评分是一种有效的临床评估工具，可识别将获得功能独立的 ICH 患者，从而为临床决策和临床试验患者选择提供指导。
Background and Purpose - Intracerebral hemorrhage (ICH) is the most fatal and disabling stroke subtype. Widely used tools for prediction of mortality are fundamentally limited in that they do not account for effects of withdrawal of care and are not designed to predict functional recovery. We developed an acute clinical score to predict likelihood of functional independence.Methods - We prospectively characterized 629 consecutive patients with ICH at hospital presentation. Predictors of functional independence (Glasgow Outcome Score >= 4) at 90 days were used to develop a logistic regression-based risk stratification scale in a random subset of two thirds and validated in the remaining one third of the cohort.Results - At 90 days, 162 (26%) patients achieved independence. Age, Glasgow Coma Scale, ICH location, volume (all P < 0.0001), and pre-ICH cognitive impairment (P=0.005) were independently associated with Glasgow Outcome Score >= 4. The FUNC score was developed as a sum of individual points (0-11) based on strength of association with outcome. In both the development and validation cohorts, the proportion of patients who achieved Glasgow Outcome Score >= 4 increased steadily with FUNC score. No patient assigned a FUNC score 80% with a score of 11 did. The predictive accuracy of the FUNC score remained unchanged when restricted to ICH survivors only, consistent with absence of confounding by early withdrawal of care.Conclusions - FUNC score is a valid clinical assessment tool that identifies patients with ICH who will attain functional independence and thus, can provide guidance in clinical decision-making and patient selection for clinical trials.