Lower admission reverse shock index multiplied by Glasgow coma scale score is associated with early hematoma expansion in spontaneous intracerebral hemorrhage.
Wu S, Chen B, Wang J • Frontiers in neurology • 2026
Lower admission rSIG (reverse shock index multiplied by Glasgow Coma Scale score) was independently and nonlinearly associated with early hematoma expansion after spontaneous intracerebral hemorrhage, with an AUC of 0.828 and optimal cutoff of 17.44.
Key Findings
Results
Early hematoma expansion occurred in 7.7% of included spontaneous intracerebral hemorrhage patients.
Of 2,450 patients screened, 2,035 were included in the final analysis.
156 patients (7.7%) developed early hematoma expansion.
Early HE was defined as an absolute hematoma-volume increase >6 mL or a relative increase >33% on follow-up non-contrast CT within 8 hours.
The study was conducted at a single center between July 2016 and June 2026 in consecutive adult sICH admissions.
The study design was retrospective.
Results
Each 5-point decrease in rSIG was independently associated with higher odds of early hematoma expansion in the fully adjusted model.
Adjusted odds ratio was 1.783 (95% CI, 1.560–2.038; p < 0.001) per 5-point decrease in rSIG.
rSIG was calculated as Glasgow Coma Scale score × systolic blood pressure / heart rate using first admission measurements.
The association was assessed using hierarchical logistic regression.
Findings remained consistent in bootstrap resampling and 1:2 matched sensitivity analyses.
Results
The association between rSIG and early hematoma expansion was nonlinear and most pronounced at low rSIG values.
Nonlinearity was confirmed with restricted cubic splines analysis (P for nonlinearity < 0.001).
The association was described as 'most pronounced at low rSIG values.'
Quartile analysis was also used to assess this relationship.
Results
The rSIG-only predictive model demonstrated good discriminative performance for early hematoma expansion.
The rSIG-only model yielded an area under the curve of 0.828 (95% CI, 0.789–0.864).
The optimal cutoff for rSIG was 17.44.
At this cutoff, sensitivity was 78.2% and specificity was 80.2%.
Calibration was described as 'acceptable.'
Results
Decision curve analysis indicated that the rSIG model provided net clinical benefit across a meaningful range of threshold probabilities.
Net benefit was indicated across threshold probabilities of approximately 1.7–30%.
Decision curve analysis was used to evaluate clinical utility of the rSIG model.
What This Means
This research suggests that a simple score calculated from three measurements routinely taken at hospital admission — blood pressure, heart rate, and level of consciousness (Glasgow Coma Scale) — can help identify patients with brain hemorrhage who are at high risk of their bleeding getting worse within hours. The score, called rSIG (reverse shock index multiplied by GCS), is computed by multiplying the Glasgow Coma Scale score by systolic blood pressure and then dividing by heart rate. Lower rSIG scores were strongly linked to a greater chance of early hematoma expansion, which is when a blood clot in the brain grows significantly larger and is a major cause of worsening neurological outcomes.
In a study of over 2,000 patients with spontaneous intracerebral hemorrhage (bleeding in the brain not caused by trauma), about 1 in 13 patients experienced early hematoma expansion. The rSIG score was able to predict this complication with an accuracy (AUC) of 0.828, and a cutoff value of 17.44 correctly identified roughly 78% of those who did expand and 80% of those who did not. These results held up across multiple statistical tests designed to check the robustness of the findings.
This research suggests that rSIG could serve as a quick bedside tool to help clinicians rapidly flag high-risk patients for closer monitoring or more intensive imaging evaluation, without requiring any additional tests beyond what is already performed on arrival. Because the study was conducted at a single center and was retrospective in design, the authors note that prospective, multi-center validation is needed before rSIG can be recommended for routine clinical use.
Wu S, Chen B, Wang J. (2026). Lower admission reverse shock index multiplied by Glasgow coma scale score is associated with early hematoma expansion in spontaneous intracerebral hemorrhage.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1947152