Comparison of predicting scales for symptomatic intracranial hemorrhage after stroke thrombolysis with recombinant tissue plasminogen activator

Juehua Zhu; Chunyan Han; Runnan LI; Yun Zhou; Xiang Tang; Dongxue Ding; Lulu Zhang; Hui Wang; Yan Kong; Xiuying Cai; Qi Fang

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Comparison of predicting scales for symptomatic intracranial hemorrhage after stroke thrombolysis with recombinant tissue plasminogen activator

VernacularTitle: 重组组织型纤溶酶原激活剂静脉溶栓后症状性颅内出血风险评估量表的对比研究
Author: Juehua ZHU ¹ ; Chunyan HAN ² ; Runnan LI ¹ ; Yun ZHOU ¹ ; Xiang TANG ¹ ; Dongxue DING ¹ ; Lulu ZHANG ¹ ; Hui WANG ¹ ; Yan KONG ¹ ; Xiuying CAI ¹ ; Qi FANG ¹
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1. Department of Neurology, the First Hospital Affiliated to Suzhou University, Suzhou 215006, China
2. Department of Neurology, Huaian First Hospital Affiliated to Nanjing Medical University, Huaian, Jiangsu 223300, China
Publication Type:Journal Article
Keywords: Stroke; Brain ischemia; Tissue plasminogen activator; Thrombolytic therapy; Cerebral hemorrhage
From: Chinese Journal of Neurology 2019;52(12):1022-1030
CountryChina
Language:Chinese
Abstract: Objective:Symptomatic intracranial hemorrhage (sICH) is one of the severe complications of ischemic stroke thrombolysis. Several prognostic scales have been developed to predict the risk of sICH. The performance of seven scales was compared in a single center cohort.
Methods:Data of patients with consecutive ischemic stroke who received 0.9 mg/kg intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis within 4.5 h time window from stroke onset were collected. Seven scales that can provide an estimate of risk of sICH were identified and evaluated: Hemorrhage After Thrombolysis (HAT), blood Sugar, Early infarct signs, (hyper) Dense cerebral artery sign, Age, National Institutes of Health (NIH) Stroke Scale (SEDAN), Stroke Prognostication using Age and NIH Stroke Scale (SPAN)-100, Safe Implementation of Thrombolysis in Stroke (SITS), Total Health Risks In Vascular Events (THRIVE), Glucose at presentation, Race (Asia), Age, Sex (male), systolic blood Pressure at presentation, and Severity of stroke at presentation (NIH Stroke Scale; GRASPS) and Multicenter Stroke Survey (MSS). The area under the receiver operating characteristic curve (AUROC) was calculated and Logistic regression and the Hosmer-Lemeshow test were also performed.
Results:The current study included 293 patients, of whom 7.85% (23/293) had sICH by National Institute of Neurological Disorders and Stroke (SICH_NINDS), 5.46% (16/293) by Europe Cooperative Acute Stroke Study Ⅱ (SICH_ECASSⅡ) and 4.44% (13/293) by Safe Implementation of Thrombolysis in Stroke (SICH_SITS) criteria. SEDAN had the highest AUROC for predicting sICH: sICH_NINDS: AUROC=0.843, OR=3.167, 95%CI 2.106-4.762, P<0.01; sICH_ECASSⅡ: AUROC=0.797, OR=2.509, 95%CI 1.652-3.812, P<0.01; sICH_SITS: AUROC=0.784, OR=2.172, 95%CI 1.405-3.357, P<0.01. And SPAN-100 had the lowest AUROC among all the seven scales and was only associated with risk of SICH_NINDS in regression analysis. Furthermore, when sub-grouped the cohort into anterior circulation infarction and posterior circulation infarction, regression analysis suggested that all the seven scales were however not associated with sICH risk in patients with posterior circulation infarction.
Conclusions:SEDAN constantly had the highest predictive power, SPAN-100 had the worst. The seven scales studied could not predict sICH in posterior circulation infarction.