BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (SICH) is a serious complication in patients with acute ischemic stroke treated with intravenous thrombolysis. We aimed to develop a clinical score that can easily be applied to predict the risk of SICH. METHODS: We analyzed data from 31 627 patients treated with intravenous alteplase enrolled in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register. The outcome measure was SICH per the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition: a Type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale score of ≥ 4 points or death. Univariate risk factors associated with the outcome were entered into a logistic regression model after stratification of continuous variables. Adjusted ORs for the independent risk factors were converted into points, which were summated to produce a risk score. RESULTS: We identified 9 independent risk factors for SICH: baseline National Institutes of Health Stroke Scale, serum glucose, systolic blood pressure, age, body weight, stroke onset to treatment time, aspirin or combined aspirin and clopidogrel, and history of hypertension. The overall rate of SICH was 1.8%. The risk score ranged from 0 to 12 points and showed a >70-fold graded increase in the rate of SICH for patients with a score ≥ 10 points (14.3%) compared with a score of 0 point (0.2%). The prognostic discriminating capability by C statistic was 0.70. CONCLUSIONS: The SITS SICH risk score predicts large cerebral parenchymal hemorrhages associated with severe clinical deterioration. The score could aid clinicians to identify patients at high as well as low risk of SICH after intravenous alteplase.
BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (SICH) is a serious complication in patients with acute ischemic stroke treated with intravenous thrombolysis. We aimed to develop a clinical score that can easily be applied to predict the risk of SICH. METHODS: We analyzed data from 31 627 patients treated with intravenous alteplase enrolled in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register. The outcome measure was SICH per the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition: a Type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale score of ≥ 4 points or death. Univariate risk factors associated with the outcome were entered into a logistic regression model after stratification of continuous variables. Adjusted ORs for the independent risk factors were converted into points, which were summated to produce a risk score. RESULTS: We identified 9 independent risk factors for SICH: baseline National Institutes of Health Stroke Scale, serum glucose, systolic blood pressure, age, body weight, stroke onset to treatment time, aspirin or combined aspirin and clopidogrel, and history of hypertension. The overall rate of SICH was 1.8%. The risk score ranged from 0 to 12 points and showed a >70-fold graded increase in the rate of SICH for patients with a score ≥ 10 points (14.3%) compared with a score of 0 point (0.2%). The prognostic discriminating capability by C statistic was 0.70. CONCLUSIONS: The SITS SICH risk score predicts large cerebral parenchymal hemorrhages associated with severe clinical deterioration. The score could aid clinicians to identify patients at high as well as low risk of SICH after intravenous alteplase.
Authors: Raul G Nogueira; Rishi Gupta; Tudor G Jovin; Elad I Levy; David S Liebeskind; Osama O Zaidat; Ansaar Rai; Joshua A Hirsch; Daniel P Hsu; Marilyn M Rymer; Ashis H Tayal; Ridwan Lin; Sabareesh K Natarajan; Ashish Nanda; Melissa Tian; Qing Hao; Junaid S Kalia; Michael Chen; Alex Abou-Chebl; Thanh N Nguyen; Albert J Yoo Journal: J Neurointerv Surg Date: 2014-01-08 Impact factor: 5.836
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Pavla Kadlecová; Anna Czlonkowska; Adam Kobayashi; Miroslav Brozman; Viktor Švigelj; Laszlo Csiba; Klara Fekete; Janika Kõrv; Vida Demarin; Aleksandras Vilionskis; Dalius Jatuzis; Yakup Krespi; Chrissoula Liantinioti; Sotirios Giannopoulos; Robert Mikulik Journal: J Neurol Date: 2017-03-18 Impact factor: 4.849
Authors: Andreas Charidimou; Marco Pasi; Marco Fiorelli; Sara Shams; Rüdiger von Kummer; Leonardo Pantoni; Natalia Rost Journal: Stroke Date: 2016-08-04 Impact factor: 7.914