External validation of different predictive scores for symptomatic intracranial hemorrhage after intravenous thrombolysis in Asian stroke patients.

Publisher: Elsevier Country of Publication: Netherlands NLM ID: 7502039 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-6968 (Electronic) Linking ISSN: 03038467 NLM ISO Abbreviation: Clin Neurol Neurosurg Subsets: MEDLINE

Publication: Amsterdam : Elsevier
Original Publication: Assen, Van Gorcum.

Intracranial Hemorrhages*/diagnostic imaging ; Stroke*/drug therapy ; Thrombolytic Therapy*/adverse effects ; Thrombolytic Therapy*/methods ; Fibrinolytic Agents*/administration & dosage ; Fibrinolytic Agents*/adverse effects ; Fibrinolytic Agents*/therapeutic use ; Tissue Plasminogen Activator*/adverse effects ; Tissue Plasminogen Activator*/therapeutic use ; Tissue Plasminogen Activator*/administration & dosage; Humans ; Male ; Female ; Middle Aged ; Aged ; Retrospective Studies ; Asian People ; Predictive Value of Tests ; Aged, 80 and over ; Administration, Intravenous

Objective: This study aimed to externally validate different predictive scores for symptomatic intracranial hemorrhage (SICH) after intravenous thrombolysis (IVT), with a particular focus on their predictive abilities in Asian stroke patients.
Methods: We retrospectively enrolled stroke patients who received a standard dose of alteplase within 4.5 hours from symptom onset at the First Affiliated Hospital of Dalian Medical University from July 2010 to August 2023. SICH was defined as the hemorrhagic transformation detected on the head CT scan completed within 48 h post-IVT, accompanied by a clinical deterioration of at least a 4-point increase in NIHSS score. Predictive abilities of the HAT, MSS, SEDAN, SPAN-100, and GRASPS scores were tested. Discrimination and calibration were performed using the area under the receiver operating characteristic curve (ROC-AUC), DeLong test, and Hosmer-Lemeshow (H-L) goodness-of-fit test.
Results: The study included 1007 stroke patients, of whom 31 (3.08 %) developed SICH. ROC-AUCs for predicting SICH were: 0.796 (95 %CI: 0.726-0.866) for the GRASPS score, 0.724 (95 %CI: 0.644-0.804) for the MSS score, 0.715 (95 %CI: 0.619-0.811) for the SEDAN score, 0.714 (95 %CI: 0.611-0.817) for the HAT score, and 0.605 (95 %CI: 0.491-0.720) for the SPAN-100 score (all P < 0.05). DeLong tests showed that the GRASPS score demonstrated significantly better discrimination than the MSS score (P = 0.010), the SEDAN score (P = 0.009), the HAT score (P = 0.049), and the SPAN-100 score (P = 0.000). H-L tests indicated good calibrations which were ranked HAT > SEDAN > MSS > SPAN-100 > GRASPS scores.
Conclusion: The GRASPS score showed reasonable predictive ability for SICH, indicating its potential utility for Asian stroke patients receiving IVT.
Competing Interests: Declaration of Competing Interest All authors declared no conflicts of interest.
(Copyright © 2024 Elsevier B.V. All rights reserved.)

Keywords: Intravenous thrombolysis; Prediction; Symptomatic intracranial hemorrhage; Validation

0 (Fibrinolytic Agents)
EC 3.4.21.68 (Tissue Plasminogen Activator)

Date Created: 20240808 Date Completed: 20240908 Latest Revision: 20240909

20240909

10.1016/j.clineuro.2024.108500

39116795