The ICH score combined with the CRP/albumin ratio as an improved early prognostic tool for in-hospital mortality in spontaneous intracerebral hemorrhage

Introduction: The ICH score is a widely used tool for predicting mortality in spontaneous intracerebral hemorrhage (sICH) patients, but its accuracy for early in-hospital prognosis remains limited. Recently, the C-reactive protein (CRP)/albumin ratio has been identified as a potential biomarker associated with in-hospital mortality (IHM) in sICH patients. Research question: This study aimed to investigate whether combining the established ICH score with the CRP/albumin ratio at admission improves the prediction of IHM in sICH patients. Material and methods: A retrospective analysis was conducted including 379 patients with sICH treated in an intensive care unit between 02/2008 and 12/2017. Based on previous findings identifying a CRP/albumin ratio >1.22 as an independent predictor of IHM, the ICH score was modified by adding one point when this threshold was exceeded. Prognostic performance of the original ICH score and the modified ICH (mICH) score was evaluated using receiver operating characteristic (ROC) analysis in the entire cohort and in subgroups of patients with Glasgow Coma Scale (GCS) ≤ 8 and intraventricular hemorrhage. Results: The mICH score demonstrated improved prognostic performance compared with the original ICH score in the overall cohort (AUC 0.776 vs. 0.761). In patients with severe neurological impairment (GCS ≤8), the predictive accuracy increased from an AUC of 0.672 to 0.719. Similarly, in patients with intraventricular hemorrhage, the AUC improved from 0.747 to 0.774. The modified score showed higher sensitivity and improved Youden index values across analyses. Discussion and conclusion: Incorporating the CRP/albumin ratio into the original ICH score was associated with modestly improved discrimination for in-hospital mortality, with more pronounced gains in patients presenting with GCS ≤8 or intraventricular hemorrhage.