Siegler James E, Alvi Muhammad, Boehme Amelia K, Lyerly Michael J, Albright Karen C, Shahripour Reza Bavarsad, Rawal Pawan V, Kapoor Niren, Sisson April, Houston J Thomas, Alexandrov Anne W, Martin-Schild Sheryl, Alexandrov Andrei V
Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
ISRN Stroke. 2013;2013:681673. doi: 10.1155/2013/681673.
Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states.
We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008-2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07-34.1, = 0.0422) when patients were dichotomized by score.
In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region.
有症状性脑出血（sICH）仍然是静脉注射组织型纤溶酶原激活剂（IV tPA）治疗最令人担忧的并发症。我们旨在研究先前经过验证的评分方法在两个美国中风带州接受治疗的患者中的表现。
我们回顾性分析了来自两个中风带州的两个中心在2008 - 2011年期间接受IV tPA治疗的连续患者。我们评估了三种模型预测sICH的能力。sICH被定义为2型脑实质出血，美国国立卫生研究院卒中量表（NIHSS）评分恶化≥4分或死亡。在457例接受IV tPA治疗的患者中，19例（4.2%）发生了sICH（平均年龄68岁，26.3%为黑人，63.2%为女性）。在整个队列中，Cucchiara模型对sICH的预测性最强（AUC：0.6528），当按评分将患者二分法分类时，在黑人中对sICH的预测性也最强（OR = 6.03，95% CI 1.07 - 34.1，P = 0.0422）。
在我们来自种族异质的美国中风带的小样本中，Cucchiara模型在预测sICH方面优于其他模型。虽然预测模型不应被用于证明不进行溶栓治疗的合理性，但那些有兴趣了解sICH相关因素的人在为本地区开发出中风带模型之前，可能会选择使用Cucchiara模型。
