Gao et al reported the INCNS score for evaluating a neurocritically ill patient. The autors are from the Fourth Military Medical University in Xi'an, China.
INCNS is an acronym for inflammation, nutrition, consciousness, neurological function and systemic condition.
Patient: ICU patient with severe neurologic disease
Outcome: modified Rankin scale, with score >= 3 unfavorable
Parameters:
(1) WBC count in 10^9/L (inflammation)
(2) axillary temperature in °C (inflammation)
(3) serum albumin in g/L (nutrition)
(4) arousal (consciousness)
(5) awareness (consciousness
(6) pupillary light reflex (neurologic function)
(7) corneal reflex (neurologic function)
(8) verbal response (neurologic function)
(9) motor response (either response to stimulus or muscle strength) (neurologic function)
(10) swallowing function (neurologic function)
(11) respiration (neurologic function)
(12) age in years (systemic condition)
(13) heart rate in beats per minute (systemic condition)
(14) systolic blood pressure in mm Hg (systemic condition)
(15) blood glucose in mmol/L (systemic condition)
(16) serum sodium in mmol/L (systemic condition)
(17) serum potassium in mmol/L (systemic condition)
(18) serum creatinine in µmol/L (systemic condition)
(19) serum total bilirubin in µmol/L (systemic condition)
|
Parameter |
Finding |
Points |
|
WBC count |
<= 2.8 * 10^9/L |
2 |
|
|
2.9 to 3.9 |
1 |
|
|
4 to 10 |
0 |
|
|
10.1 to 25 |
1 |
|
|
> 35 |
2 |
|
axillary temperature |
< 36°C |
1 |
|
|
36 to 38.4 |
0 |
|
|
38.5 to 40 |
1 |
|
|
> 40 |
2 |
|
serum albumin |
>= 35 g/L |
0 |
|
|
25 to 34.9 |
1 |
|
|
< 25 |
2 |
|
arousal |
spontaneous eye opening |
0 |
|
|
eyes open to verbal command |
1 |
|
|
eyes opening to pain |
2 |
|
|
no eye opening |
3 |
|
awareness |
correct response to question or command |
0 |
|
|
confused response |
1 |
|
|
non-reflex movements |
2 |
|
|
none |
3 |
|
pupillary light reflex |
bilateral sensitive |
0 |
|
|
unilateral slow or absent |
2 |
|
|
bilateral slow or absent |
3 |
|
corneal reflex |
bilateral sensitive |
0 |
|
|
unilateral slow or absent |
2 |
|
|
bilateral slow or absent |
3 |
|
verbal response |
accurate speech |
0 |
|
|
confused/inappropriate speech |
1 |
|
|
incomprehensible speech or none |
2 |
|
motor, response |
obeys commands |
0 |
|
|
localizes or withdraws from pain |
1 |
|
|
flexing/extending to pain |
2 |
|
|
none |
3 |
|
motor, muscle strength |
muscle strength >= 4 |
0 |
|
|
muscle strength 2 or 3 |
1 |
|
|
unilateral muscle strength <= 1 |
2 |
|
|
bilateral muscle strength <= 1 |
3 |
|
swallowing function |
water swallow test I or II |
0 |
|
|
water swallow test III or IV |
1 |
|
respiration |
< 12 breaths/min, not intubated |
1 |
|
|
12-24, not intubated |
0 |
|
|
> 24, not intubated |
1 |
|
|
breathes above ventilator rate |
2 |
|
|
breathes at ventilator rate, apnea |
3 |
|
age |
<= 44 years |
0 |
|
|
45 to 64 |
1 |
|
|
65 to 74 |
2 |
|
|
>= 75 |
3 |
|
heart rate |
< 40 beats per minute |
2 |
|
|
40 to 59 |
1 |
|
|
60 to 100 |
0 |
|
|
101 to 149 |
1 |
|
|
> 149 |
2 |
|
systolic blood pressure |
< 70 mm Hg |
2 |
|
|
70 to 89 |
1 |
|
|
90 to 140 |
0 |
|
|
141 to 199 |
1 |
|
|
> 199 |
2 |
|
blood glucose |
< 2.2 mmol/L |
2 |
|
|
2.2 to 3.8 |
1 |
|
|
3.9 to 11.1 |
0 |
|
|
11.2 to 19.3 |
1 |
|
|
> 19.3 |
2 |
|
serum sodium |
< 120 mmol/L |
2 |
|
|
120 to 129 |
1 |
|
|
130 to 150 |
0 |
|
|
151 to 159 |
1 |
|
|
> 159 |
2 |
|
serum potassium |
< 2.5 mmol/L |
2 |
|
|
2.5 to 3.4 |
1 |
|
|
3.5 to 5.5 |
0 |
|
|
5.6 to 6.9 |
1 |
|
|
> 6.9 |
2 |
|
serum creatinine |
< 44 µmol/L |
1 |
|
|
44 to 132 |
0 |
|
|
133 to 171 |
1 |
|
|
> 171 |
2 |
|
serum total bilirubin |
< 34.2 µmol/L |
0 |
|
|
34.2 to 102.5 |
1 |
|
|
> 102.5 |
2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 44
• The higher the score the worse the 3-month functional outcome.
value of X =
= (-0.002512 * ((score)^2)) + (0.3169 * (score)) - 2.159
probability of unfavorable outcome using 72-hour INCNS =
= 1 / (1+EXP((-1) * X))
Performance:
• The area under the ROC curve for 3-month functional outcome based on 24 hour INCNS was 0.79.
• The area under the ROC curve for 3-month functional outcome based on 72 hour INCNS was 0.79.
Specialty: Critical Care
