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The AVICH-score: A novel grading system to predict clinical outcome in arteriovenous malformations related intracerebral hemorrhage


Neidert, Marian C; Lawton, Michael T; Mader, Marius; Seifert, Burkhardt; Valavanis, Antonios; Regli, Luca; Bozinov, Oliver; Burkhardt, Jan-Karl (2016). The AVICH-score: A novel grading system to predict clinical outcome in arteriovenous malformations related intracerebral hemorrhage. World Neurosurgery, 92:292-297.

Abstract

OBJECTIVE To establish an arteriovenous malformation (AVM) grading score for patients with ruptured AVM and associated intracerebral hemorrhage (ICH) to predict clinical outcome. METHODS Patient data from 01/2006 to 12/2013 with newly diagnosed ICH due to ruptured AVM and a modified Rankin Scale (mRS) <2 before ICH were included for this analysis. Clinical outcome was dichotomized in favorable (mRS 0-2) and unfavorable (mRS 3-6) to find predictors for outcome and to establish a new score based on the areas under the receiver-operating characteristic curves (AUROC) at 3 months, 1 year and at last follow-up (mean 31 months). RESULTS A total of 67 patients (mean age 41 years, 66% male) were analyzed including 39 patients with favorable and 28 with unfavorable outcome. Intraventricular hemorrhage (p=0.048), ICH score (p=0.003), AVM size (p<0.001), Spetzler-Martin grade (p<0.001), nidus structure (p=0.005), Lawton-Young grade (p=0.015) and supplemented Spetzler-Martin score (p<0.001) were significant predictors for clinical outcome in ruptured AVMs. Based on these results, we created a new score named the AVICH (AVM-related ICH) score, which showed an AUROC of 0.842 compared to 0.789 for the supplemented Spetzler-Martin grading system and 0.703 for the ICH score regarding clinical outcome at last follow-up. CONCLUSIONS Based on the AUROC analysis the AVICH score predicts outcome of patients with ruptured AVM and associated ICH better than the ICH score, the Spetzler-Martin or the supplemented Spetzler-Martin grading system. An external validation is needed before the AVICH score will be tested in a prospective multicenter cohort.

Abstract

OBJECTIVE To establish an arteriovenous malformation (AVM) grading score for patients with ruptured AVM and associated intracerebral hemorrhage (ICH) to predict clinical outcome. METHODS Patient data from 01/2006 to 12/2013 with newly diagnosed ICH due to ruptured AVM and a modified Rankin Scale (mRS) <2 before ICH were included for this analysis. Clinical outcome was dichotomized in favorable (mRS 0-2) and unfavorable (mRS 3-6) to find predictors for outcome and to establish a new score based on the areas under the receiver-operating characteristic curves (AUROC) at 3 months, 1 year and at last follow-up (mean 31 months). RESULTS A total of 67 patients (mean age 41 years, 66% male) were analyzed including 39 patients with favorable and 28 with unfavorable outcome. Intraventricular hemorrhage (p=0.048), ICH score (p=0.003), AVM size (p<0.001), Spetzler-Martin grade (p<0.001), nidus structure (p=0.005), Lawton-Young grade (p=0.015) and supplemented Spetzler-Martin score (p<0.001) were significant predictors for clinical outcome in ruptured AVMs. Based on these results, we created a new score named the AVICH (AVM-related ICH) score, which showed an AUROC of 0.842 compared to 0.789 for the supplemented Spetzler-Martin grading system and 0.703 for the ICH score regarding clinical outcome at last follow-up. CONCLUSIONS Based on the AUROC analysis the AVICH score predicts outcome of patients with ruptured AVM and associated ICH better than the ICH score, the Spetzler-Martin or the supplemented Spetzler-Martin grading system. An external validation is needed before the AVICH score will be tested in a prospective multicenter cohort.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neuroradiology
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2 May 2016
Deposited On:02 Jun 2016 14:51
Last Modified:08 Dec 2017 19:36
Publisher:Elsevier
ISSN:1878-8750
Publisher DOI:https://doi.org/10.1016/j.wneu.2016.04.080
PubMed ID:27150647

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