Pre-admission CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after first spontaneous intracranial hemorrhage

Abstract Background: Spontaneous intracranial hemorrhage (ICH) results in significant morbidity and mortality. Approximately 50% patients die within the first 30 days of the index hemorrhage, and of those who survive, only a minority is expected to be functionally independent. The ability to predict long-term functional outcomes may facilitate decision making in early management of ICH. This study aim to evaluate for the first time whether CHADS 2 score and CHA 2 DS 2 -VASc developed to stratify the risk of ischemic stroke among patients with AF is useful in predicting the functional outcomes among patients surviving their first spontaneous ICH. Methods: This single-centered observational registry was carried out between 1996 and 2010 and included 691 consecutive patients with the first spontaneous ICH. Results: Amongst these, 427 patients (60.1 ± 15.2 years, male: 62.5%) surviving the 30 days after the first ICH fulfilling the inclusion criteria were studied. At 1 year and 2 years, 52.9% and 54.8% patients had unfavorable outcome as defined as modified Rankin score of ≥3. In both univariate and multivariate analysis, increasing age, a higher pre-admission CHADS 2 and CHA 2 DS 2 -VASc scores surgical intervention for the ICH were associated with unfavorable outcomes. The c statistic of the CHADS 2 score as a predictor of favorable outcome was 0.59 (95% CI: 0.54-0.64, p <0.0001) with the optimal cutoff to predict favorable outcome at CHADS 2 ³1 with sensitivity of 73.9% and specificity of 39.4%. On the other hand, the C statistic of the CHA 2 DS 2 -VASc score to predict favorable outcome was similar to that of the CHADS 2 score (C-statistic: 0.58, 95% CI: 0.53-0.63, p =0.003) with the optimal cutoff at CHA 2 DS 2 -VASc ³3. The sensitivity and specificity were 67.7% and 46.3% respectively. Conclusion: The outcome of ICH patients surviving the first 30 days was poor. CHADS 2 and CHA 2 DS 2 -VASc appeared to be a reasonable score to predict long-term ICH outcomes.