Manuel Cappellari1, Gianni Turcato2, Stefano Forlivesi2, Cecilia Zivelonghi2, Paolo Bovi2, Bruno Bonetti2, Danilo Toni2. 1. From the DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., C.Z., P.B., B.B.); Emergency Department, Girolamo Fracastoro Hospital San Bonifacio (Verona), Italy (G.T.); and Dipartimento di Neurologia e Psichiatria, Università degli Studi di Roma "La Sapienza," Italy (D.T.). manuel_cappellari@libero.it. 2. From the DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., C.Z., P.B., B.B.); Emergency Department, Girolamo Fracastoro Hospital San Bonifacio (Verona), Italy (G.T.); and Dipartimento di Neurologia e Psichiatria, Università degli Studi di Roma "La Sapienza," Italy (D.T.).
Abstract
BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (sICH) is a rare but the most feared complication of intravenous thrombolysis for ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of sICH in intravenous thrombolysis-treated stroke patients included in the multicenter SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register). METHODS: All patients registered in the SITS-ISTR by 179 Italian centers between May 2001 and March 2016 were originally included. The main outcome measure was sICH per the European Cooperative Acute Stroke Study II definition (any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline or death <7 days). On the basis of multivariate logistic model, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver-operating characteristic curve and calibration of risk prediction model by using the Hosmer-Lemeshow test. RESULTS: A total of 15 949 patients with complete data for generating the nomogram was randomly dichotomized into training (3/4; n=12 030) and test (1/4; n=3919) sets. After multivariate logistic regression, 10 variables remained independent predictors of sICH to compose the STARTING-SICH (systolic blood pressure, age, onset-to-treatment time for thrombolysis, National Institutes of Health Stroke Scale score, glucose, aspirin alone, aspirin plus clopidogrel, anticoagulant with INR ≤1.7, current infarction sign, hyperdense artery sign) nomogram. The area under the receiver-operating characteristic curve of STARTING-SICH was 0.739. Calibration was good (P=0.327 for the Hosmer-Lemeshow test). CONCLUSIONS: The STARTING-SICH is the first nomogram developed and validated in a large SITS-ISTR cohort for individualized prediction of sICH in intravenous thrombolysis-treated stroke patients.
BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (sICH) is a rare but the most feared complication of intravenous thrombolysis for ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of sICH in intravenous thrombolysis-treated strokepatients included in the multicenter SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register). METHODS: All patients registered in the SITS-ISTR by 179 Italian centers between May 2001 and March 2016 were originally included. The main outcome measure was sICH per the European Cooperative Acute Stroke Study II definition (any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline or death <7 days). On the basis of multivariate logistic model, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver-operating characteristic curve and calibration of risk prediction model by using the Hosmer-Lemeshow test. RESULTS: A total of 15 949 patients with complete data for generating the nomogram was randomly dichotomized into training (3/4; n=12 030) and test (1/4; n=3919) sets. After multivariate logistic regression, 10 variables remained independent predictors of sICH to compose the STARTING-SICH (systolic blood pressure, age, onset-to-treatment time for thrombolysis, National Institutes of Health Stroke Scale score, glucose, aspirin alone, aspirin plus clopidogrel, anticoagulant with INR ≤1.7, current infarction sign, hyperdense artery sign) nomogram. The area under the receiver-operating characteristic curve of STARTING-SICH was 0.739. Calibration was good (P=0.327 for the Hosmer-Lemeshow test). CONCLUSIONS: The STARTING-SICH is the first nomogram developed and validated in a large SITS-ISTR cohort for individualized prediction of sICH in intravenous thrombolysis-treated strokepatients.
Authors: Rody El Nawar; Jennifer Yeung; Julien Labreuche; Marie-Laure Chadenat; Duc Long Duong; Maxime De Malherbe; Yves-Sebastien Cordoliani; Bertrand Lapergue; Fernando Pico Journal: Front Neurol Date: 2019-08-27 Impact factor: 4.003
Authors: Xiaohao Zhang; Kang Yuan; Huaiming Wang; Pengyu Gong; Teng Jiang; Yi Xie; Lei Sheng; Dezhi Liu; Xinfeng Liu; Gelin Xu Journal: J Am Heart Assoc Date: 2020-01-24 Impact factor: 5.501