Department of Neurology, Seoul Medical Center, Seoul, Korea.
Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):367-73. doi: 10.1016/j.jstrokecerebrovasdis.2013.05.025. Epub 2013 Jun 22.
Despite substantial differences in clinical features between Asian and Western stroke patients, there are no published prognostic tools validated in an Asiatic population for thrombolytic therapy. We assessed the ability of the iScore to predict the clinical response after intravenous thrombolysis with tissue plasminogen activator (tPA) in a Korean stroke population.
We applied the iScore to eligible participants in the nationwide multicenter stroke registry in Korea. Main outcome measures were poor functional outcome defined as having a modified Rankin Scale score 3-6 and death at 3 months. Symptomatic intracranial hemorrhage (sICH) was evaluated as a safety outcome. C statistic was calculated to assess performance of iScore.
Among 4760 patients with an acute ischemic stroke, 622 (13.1%) received tPA, 548 patients had complete information for the analysis. C statistics for poor functional outcome and death at 3 months were .813 (95% confidence interval [CI]: .778-.848) and .820 (95% CI: .769-.872), respectively. Overall, there was a high correlation between observed and expected outcome for poor functional outcome (Pearson correlation coefficient, r = .982) and for death at 3 months (r = .950) at the risk score level. An iScore of 180 or more was associated with a more than 2 times risk of poor functional outcome and about 6 times risk of death at 3 months. There was an interaction between the iScore and tPA for a poor functional outcome (P value for the interaction < .001). We found a gradient effect in the incident risk of sICH with the iScore.
The iScore reliably predicts stroke outcomes after tPA in Asiatic population.
尽管亚洲和西方脑卒中患者的临床特征存在很大差异，但目前尚无针对亚洲人群的溶栓治疗的经验证的预后工具。我们评估了 iScore 在韩国脑卒中人群中预测静脉溶栓治疗组织型纤溶酶原激活剂（tPA）后临床反应的能力。
我们将 iScore 应用于韩国全国多中心脑卒中注册研究中的合格患者。主要转归指标为功能不良结局，定义为改良 Rankin 量表评分 3-6 分和 3 个月时死亡。症状性颅内出血（sICH）作为安全性结局进行评估。计算 C 统计量评估 iScore 的性能。
在 4760 例急性缺血性脑卒中患者中，622 例（13.1%）接受了 tPA 治疗，548 例患者的资料完整可供分析。功能不良结局和 3 个月时死亡的 C 统计量分别为 0.813（95%置信区间[CI]：0.778-0.848）和 0.820（95% CI：0.769-0.872）。总体而言，iScore 水平的不良功能结局（Pearson 相关系数，r = 0.982）和 3 个月时死亡（r = 0.950）的观察结果与预期结果高度相关。iScore 为 180 或更高与不良功能结局的风险增加 2 倍以上和 3 个月时死亡的风险增加 6 倍以上相关。iScore 和 tPA 之间存在功能不良结局的交互作用（交互作用 P 值<0.001）。我们发现 iScore 与 sICH 的发病风险之间存在梯度效应。
iScore 可靠地预测亚洲人群 tPA 治疗后的脑卒中结局。
