# ICCTUS score - Inspiration, Circulation and Consciousness predicting the Threat for an Unfavorable Outcome after SAH

## TL;DR

The ICCTUS score, based on organ failure assessment, predicts poor neurological outcomes after subarachnoid hemorrhage better than existing scores.

## Contribution

The ICCTUS score is a novel, CNS-focused adaptation of the SOFA score that improves outcome prediction after SAH.

## Key findings

- The ICCTUS score achieved an AUC of 0.8 for predicting unfavorable outcomes after SAH.
- ICCTUS outperformed WFNS (AUC 0.71) and HH (AUC 0.64) in outcome prediction.
- The score combines CNS, cardiovascular, and respiratory subscores for high sensitivity and specificity.

## Abstract

We previously developed a novel score derived from the Sequential Organ Failure Assessment score and demonstrated its ability to predict delayed cerebral ischemia-associated infarctions following spontaneous subarachnoid hemorrhage. In the current study, we investigated whether the new score (ICCTUS score) can predict neurological outcome.

We retrospectively evaluated all SAH patients in our neurosurgical ICU during a 10-year period. Patients were included if clinical data were available to determine SOFA and ICCTUS scores. Outcome was objectified by the modified Rankin Scale (mRS) after 6 months. Every parameter of the SOFA score was graded for its predictive value and combinations were tested using ROC analysis.

430 patients fulfilled the inclusion criteria (68.14% female, mean age: 56.8 ± 12.5 years). Median SOFA and ICCTUS scores were 5. The SOFA score had an AUC of 0.76 for prediction of unfavorable outcome. In comparison, the WFNS achieved an AUC of 0.71, and the HH an AUC of 0.64. For the ICCTUS score, which is based exclusively on the subscores rating the central nervous system, the cardiovascular system, and the respiratory system the AUC was at 0.8 with a sensitivity of 0.74, a specificity of 0.74, a PPV of 0.83 and a NPV of 0.62. The Youden index was 0.48 (cut-off ≥3 points).

The ICCTUS score was at least equal or superior to the established scores in predicting unfavorable outcome after SAH. The score could be implemented as an additional tool in multimodal diagnostics to identify patients at high risk.