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.
Neidert, Marian C