Abstract DP019: Early Therapy Intensity Level is Associated with 1 Year Modified Rankin Scale after Intracerebral Hemorrhage: A MISTIE-III Secondary Analysis

Objectives: Acute care bundles have reduced morbidity and mortality after intracerebral hemorrhage (ICH), but the optimal bundle composition and the timing of its use remain unclear especially in surgically treated ICH. We developed a Therapy Intensity Level (TIL) score, an unweighted composite of seven physiological risk factors previously linked to poorer ICH outcomes and assessed its association with 1-year functional outcome using the MISTIE-III trial of minimally invasive surgery for supratentorial ICH. Methods: The TIL score was derived from pre-specified trial variables and included points for uncontrolled hypertension, hypotension, hyperglycemia, hyperpyrexia, elevated INR, raised intracranial pressure, and cerebral herniation. We calculated TIL scores at baseline and at day 7 for 499 and 473 patients, respectively from the MISTIE-III cohort with available data. Partial proportional odds regression analysis was performed between TIL score and 1-year modified Rankin scale (mRS) adjusting for end of treatment hematoma volume <15ml and an ICH severity index, a previously validated composite score reflecting disease severity and patient comorbidities. Predicted cumulative probabilities of functional outcome were calculated for each TIL score using the partial proportional odds models. Results: Median baseline ICH volume was 45.6 (iqr 23.1) mL, mean age was 61.1 (SD, 12.3) years, and 194 (38.9%) patients were female. Individually, higher baseline TIL score (OR, 1.30; 95% CI, 1.04–1.62) and day 7 TIL score (OR, 1.23; 95% CI, 1.03–1.48) were each significantly associated with worse 1-year mRS. When both scores were included simultaneously in the model, the associations were attenuated and did not reach conventional statistical significance (baseline: OR, 1.22; 95% CI, 0.96–1.54; P=0.099; day 7: OR, 1.17; 95% CI, 0.97–1.42; P=0.107). No significant interaction was observed between treatment status and TIL score. In the predicted cumulative probability plot, baseline and day 7 TIL scores were independently associated with an increased probability of higher mRS at day 365 across all mRS thresholds. Conclusion: Higher TIL scores at baseline and day 7 were each associated with increased likelihood of worse functional outcome at 1 year. These findings suggest that the TIL score may serve as a useful metric as part of an acute care bundle in ICH, with persistently elevated scores potentially indicating ongoing or cumulative physiological harm.