Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
Int J Stroke. 2011 Apr;6(2):109-11. doi: 10.1111/j.1747-4949.2010.00556.x. Epub 2010 Dec 16.
Two clinical risk scores, the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores, have been proposed to predict the risk of intracerebral haemorrhage following thrombolysis in acute ischaemic stroke.
To validate Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores as predictors of post-tissue plasminogen activator symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage in an independent cohort.
Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were calculated for the cohort of tissue plasminogen activator-treated patients enrolled in the placebo arms of the SAINT-I and SAINT-II trials. The absolute risk of symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage associated with each scoring system was determined. The overall predictive value was assessed using c-statistics.
Symptomatic intracerebral haemorrhage occurred in 5.6% of 965 patients treated with tissue plasminogen activator in the SAINT cohorts. The risk of symptomatic intracerebral haemorrhage was modestly greater, with higher Haemorrhage After Thrombolysis scores (0: 4.1%, 1: 4.1%, 2: 8.8%, 3: 12.5%, 4: 0%, 5: no subjects). Similar results were seen with the Multicentre Stroke Survey score (0: 0%, 1: 4.8%, 2: 2.3%, 3: 7.3%, 4: 6.3%). In logistic regression, the Haemorrhage After Thrombolysis score was associated with the risk of symptomatic intracerebral haemorrhage (odds ratio = 1.41 per point, 95% confidence interval: 1.05-1.89, P = 0.021) and asymptomatic intracerebral haemorrhage (odds ratio = 1.59 per point, 95% confidence interval: 1.33-1.92, P< 0.001). The Multicentre Stroke Survey score was modestly associated with the risk of symptomatic intracerebral haemorrhage (odds ratio = 1.43 per point, 95% confidence interval: 0.95-2.15, P = 0.084) and asymptomatic intracerebral haemorrhage (odds ratio = 1.63 per point, 95% confidence interval: 1.27-2.08, P < 0.001). The c-statistic was 0.59 for predicting symptomatic intracerebral haemorrhage and 0.61 for asymptomatic intracerebral haemorrhage for both the Haemorrhage After Thrombolysis and the Multicentre Stroke Survey scores.
While both the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were associated with a risk of symptomatic intracerebral haemorrhage, discriminatory ability was limited.
有两种临床风险评分，即溶栓后出血和多中心卒中调查评分，用于预测急性缺血性卒中溶栓后颅内出血的风险。
在独立队列中验证溶栓后出血和多中心卒中调查评分对组织型纤溶酶原激活物治疗患者的症状性颅内出血和无症状性颅内出血的预测作用。
计算了组织型纤溶酶原激活物治疗的 SAINT-I 和 SAINT-II 试验安慰剂组患者的溶栓后出血和多中心卒中调查评分。确定了每个评分系统与症状性颅内出血和无症状性颅内出血相关的绝对风险。使用 C 统计量评估整体预测价值。
SAINT 队列中，965 例接受组织型纤溶酶原激活物治疗的患者中，有 5.6%发生症状性颅内出血。溶栓后出血评分较高的患者，其发生症状性颅内出血的风险也较高（0：4.1%，1：4.1%，2：8.8%，3：12.5%，4：0%，5：无患者）。多中心卒中调查评分也出现了类似的结果（0：0%，1：4.8%，2：2.3%，3：7.3%，4：6.3%）。在逻辑回归中，溶栓后出血评分与症状性颅内出血的风险相关（比值比=每点 1.41，95%置信区间：1.05-1.89，P=0.021）和无症状性颅内出血（比值比=每点 1.59，95%置信区间：1.33-1.92，P<0.001）。多中心卒中调查评分与症状性颅内出血的风险中度相关（比值比=每点 1.43，95%置信区间：0.95-2.15，P=0.084）和无症状性颅内出血（比值比=每点 1.63，95%置信区间：1.27-2.08，P<0.001）。溶栓后出血和多中心卒中调查评分预测症状性颅内出血的 C 统计量分别为 0.59 和 0.61，预测无症状性颅内出血的 C 统计量分别为 0.59 和 0.61。
尽管溶栓后出血和多中心卒中调查评分均与症状性颅内出血风险相关，但区分能力有限。
