Asuzu David, Nyström Karin, Amin Hardik, Schindler Joseph, Wira Charles, Greer David, Chi Nai Fang, Halliday Janet, Sheth Kevin N
Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA,
Neurocrit Care. 2015 Oct;23(2):166-71. doi: 10.1007/s12028-015-0131-z.
IV Thrombolysis (rt-PA) for ischemic stroke treatment carries a substantial risk for symptomatic intracerebral hemorrhage (sICH). Our purpose was to develop a computationally simple and accurate sICH predictor METHODS : Our derivation dataset consisted of 210 ischemic stroke patients receiving IV rt-PA from January 2009 until July 2013 at Yale-New Haven Hospital. Our validation dataset included 303 patients who received IV rt-PA during the NINDS rt-PA trial. Independent sICH predictors were identified by logistic regression and combined to form the TURN score. Predictive ability and goodness of fit were quantified by odds ratios (OR) and areas under the receiver operating characteristic curve (AUROC).
3 out of 17 clinical parameters were identified as independent predictors of sICH: prestroke mRS score (OR 1.54, P = 0.02), baseline NIHSS score (OR 1.13, P = 0.002), and platelet count (OR 0.99, P = 0.04). We combined these three parameters to form the TURNP score. For added simplicity, prestroke mRS score and baseline NIHSS score alone were also combined to form the TURN score, and predicted sICH without a significant drop in OR or AUROC.
We developed a new score for predicting sICH after IV thrombolysis. Our score is simple and with acceptable accuracy, making it ideal for use in the hyperacute stroke setting.
静脉注射溶栓药物（rt-PA）治疗缺血性卒中存在显著的症状性颅内出血（sICH）风险。我们的目的是开发一种计算简单且准确的sICH预测模型。方法：我们的推导数据集包括2009年1月至2013年7月在耶鲁-纽黑文医院接受静脉注射rt-PA治疗的210例缺血性卒中患者。我们的验证数据集包括在国立神经疾病与卒中研究所（NINDS）rt-PA试验期间接受静脉注射rt-PA治疗的303例患者。通过逻辑回归确定独立的sICH预测因素，并将其组合形成TURN评分。通过比值比（OR）和受试者操作特征曲线下面积（AUROC）对预测能力和拟合优度进行量化。结果：17个临床参数中有3个被确定为sICH的独立预测因素：卒中前改良Rankin量表（mRS）评分（OR 1.54，P = 0.02）、基线美国国立卫生研究院卒中量表（NIHSS）评分（OR 1.13，P = 0.002）和血小板计数（OR 0.99，P = 0.04）。我们将这三个参数组合形成TURNP评分。为了进一步简化，仅将卒中前mRS评分和基线NIHSS评分组合形成TURN评分，且预测sICH时OR或AUROC没有显著下降。结论：我们开发了一种新的评分系统来预测静脉溶栓后的sICH。我们的评分简单且准确性可接受，使其非常适合在超急性卒中环境中使用。
