Supplementary Material for: Intraventricular Extension of Supratentorial Intracerebral Hemorrhage: The Modified Graeb Scale Improves Outcome Prediction in Lund Stroke Register

<b><i>Background/Aims:</i></b> The modified Graeb Scale (mGS) is a semi-quantitative method to assess the extension of intraventricular hemorrhage (IVH) in patients with intracerebral hemorrhage (ICH). The mGS has been shown to prognosticate outcome after ICH in cohorts derived from convenience samples. We evaluated the external validity of mGS in supratentorial ICH-patients from an unselected cohort. <b><i>Methods:</i></b> ICH-patients were included prospectively and consecutively in Lund Stroke Register. Follow-up survival status was obtained from the National Census Office; functional outcome was obtained from the Swedish Stroke Register or medical records. Using multivariate analyses, we examined if mGS was related to 30-day survival or poor functional outcome (modified Rankin Scale ≥4) at 90 days. <b><i>Results:</i></b> Of 198 supratentorial ICH-patients, 86 (43%) had IVH (median mGS 12, range 1-28). In multivariate regression analyses, the mGS independently predicted 30-day mortality (per point; OR 1.16; 95% CI 1.06-1.27; p = 0.002) and poor functional outcome (OR 1.11; 95% CI 1.02-1.20; p = 0.011) after ICH. In receiver-operator characteristic analysis, the addition of mGS tended to be associated with a higher prognostic accuracy for survival (area under curve 0.886 vs. not including mGS 0.812; p = 0.053). <b><i>Conclusions:</i></b> The mGS improves outcome prediction after supratentorial ICH beyond other previously established factors in an unselected population.

背景与目的：改良格拉布量表（modified Graeb Scale, mGS）是一种半定量评估方法，用于评估脑出血（intracerebral hemorrhage, ICH）患者的脑室内出血（intraventricular hemorrhage, IVH）累及范围。既往研究已证实，基于便利样本来源的队列中，改良格拉布量表可预测脑出血患者的预后。本研究针对未经过筛选的幕上脑出血患者队列，评估改良格拉布量表的外部有效性。
方法：本研究前瞻性、连续性纳入隆德卒中登记库（Lund Stroke Register）中的脑出血患者。随访生存状态数据取自国家人口普查办公室，功能预后数据取自瑞典卒中登记库或患者病历资料。通过多变量分析，我们探究改良格拉布量表是否与脑出血患者的30天生存率以及90天不良功能预后（改良Rankin量表（modified Rankin Scale）评分≥4）相关。
结果：在198例幕上脑出血患者中，86例（43%）合并脑室内出血，改良格拉布量表评分中位数为12，范围为1~28。多变量回归分析显示，改良格拉布量表可独立预测脑出血患者的30天死亡率（每增加1分，比值比（odds ratio, OR）=1.16，95%置信区间（confidence interval, CI）：1.06~1.27，p=0.002）以及不良功能预后（OR=1.11，95%CI：1.02~1.20，p=0.011）。受试者工作特征（receiver-operator characteristic, ROC）分析显示，将改良格拉布量表纳入预后模型后，患者生存率的预测准确度趋于提升（曲线下面积（area under curve, AUC）为0.886，未纳入量表时为0.812；p=0.053）。
结论：在未经过筛选的幕上脑出血人群中，改良格拉布量表可在其他已确立的预后因素基础上，进一步提升患者的预后预测效能。