There is growing evidence that an increased C-reactive protein (CRP)/albumin ratio is associated with a higher risk of intrahospital mortality in patients with spontaneous intracerebral hemorrhage (sICH). The purpose of this study was to test whether the combination of the CRP/albumin-ratio and the ICH score (ICH-CRP/Alb score) could improve the prediction of compared to the established ICH score alone.
In this retrospective study, 379 patients with sICH between 02/2008 and 12/2017 were included. Blood samples were collected on admission and patients' demographic, medical and radiologic data were collected. The ICH score on admission was then assessed with an additional point if the CRP/albumin ratio was > 1.22. For a detailed evaluation, subgroups of patients with GCS ≤ 8 and for patients with intraventricular hemorrhage (IVH) were analyzed.
The ROC analysis of the ICH score combined with a CRP/albumin ratio showed a higher AUC (AUC: 0.776, cut-off: ≥ 3, sensitivity: 0.907, specificity: 0.498, Youden index: 0.409) than the ICH score alone (AUC: 0.761, cut-off: ≥ 3, sensitivity: 0.881, specificity: 0.479, Youden index: 0.402). For patients with an initial GCS ≤8 (n=169) an improved prediction of intrahospital mortality for the ICH-CRP/Alb score (AUC: 0.719, cut-off ICH score ≥3, sensitivity 0.706, specificity 0.322, Youden index: 0.384) compared to the ICH score (AUC: 0. 672; cut-off ICH score ≥ 3, sensitivity: 0.588, specificity: 0.309, Youden index 0.279) was observed. For patients with IVH (n=269) the ICH-CRP/Alb score (AUC: 0.774, cut-off ICH score ≥ 4, sensitivity 0.687, specificity 0.271, Youden index 0.416) was also superior to the ICH score (AUC: 0.747, cut-off ICH score ≥ 4, sensitivity 0.596, specificity 0.235, Youden index 0.361).
The ICH score in combination with the CRP/albumin ratio showed an improvement in the prediction in the of intrahospital mortality compared to the original ICH score. The highest benefit in the prediction of intrahospital mortality was found in critically ill patients with IVH or low GCS.