The AVICH Score: A Novel Grading System to Predict Clinical Outcome in Arteriovenous Malformation-Related Intracerebral Hemorrhage

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 January 2006 to December 2013 with newly diagnosed ICH caused by ruptured AVM and a modified Rankin Scale (mRS) score <2 before ICH were included for this analysis. Clinical outcome was dichotomized in favorable (mRS score, 0-2) and unfavorable (mRS score, 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 is tested in a prospective multicenter cohort.

Keywords: AVM grading system; Arteriovenous malformation; Intracerebral hemorrhage; Lawton-Young grade; Spetzler-Martin grade; Supplemented Spetzler-Martin grade.