Asuzu David, Nyström Karin, Schindler Joseph, Wira Charles, Greer David, Halliday Janet, Sheth Kevin N
Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA,
Neurocrit Care. 2015 Oct;23(2):172-8. doi: 10.1007/s12028-015-0154-5.
We developed the TURN score for predicting symptomatic intracerebral hemorrhage (sICH) after IV thrombolysis. Our purpose was to evaluate its ability to predict 90-day outcome.
We retrospectively analyzed data from 303 patients who received IV rt-PA during the NINDS rt-PA trial. Severe outcome was defined as 90-day modified Rankin scale (mRS) scores ≥5, 90-day Barthel index (BI) scores <60 and 90-day Glasgow Outcome Scale (GOS) scores >2. Excellent outcome was defined as 90-day mRS scores ≤1, 90-day BI scores ≥95 and 90-day GOS scores = 1. Agreement between TURN and 90-day outcome was assessed by univariate logistic regression reporting odds ratios (OR) and by areas under the receiver operating characteristic curves (AUROC). TURN was also compared with 6 other scores for predicting sICH or severe outcome.
TURN predicted 90-day mRS ≥5 with OR 5.73, 95% confidence interval (3.60, 9.10), P < 0.001 and AUROC 0.83, 95% confidence interval (0.77, 0.89). TURN also predicted 90-day mRS ≤1 with OR 5.24, 95% confidence interval (3.43, 7.99), P < 0.001 and AUROC 0.80, 95% confidence interval (0.74, 0.85). TURN predicted 90-day mRS ≥5 with OR significantly higher than DRAGON (2.30, P = 0.01), ASTRAL (1.18, P < 0.001), HAT (2.89, P = 0.05) and SEDAN (2.16, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.64, P < 0.001) and SEDAN (0.71, P = 0.01). Likewise, TURN predicted 90-day mRS ≤1 with OR significantly higher than Stroke-TPI (2.89, P = 0.05), DRAGON (2.29, P = 0.01), ASTRAL (1.15, P < 0.001), HAT (2.71, P = 0.04) and SEDAN (2.15, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.58, P < 0.001) and SEDAN (0.70, P = 0.01). Similar results were obtained using 90-day BI and 90-day GOS scores.
TURN predicted 90-day outcome with comparable or better accuracy compared to several existing clinical scores.
我们开发了TURN评分来预测静脉溶栓后症状性脑出血（sICH）。我们的目的是评估其预测90天预后的能力。
我们回顾性分析了在NINDS rt-PA试验中接受静脉注射rt-PA的303例患者的数据。严重预后定义为90天改良Rankin量表（mRS）评分≥5、90天Barthel指数（BI）评分<60以及90天格拉斯哥预后量表（GOS）评分>2。通过单因素逻辑回归报告比值比（OR）以及受试者工作特征曲线下面积（AUROC）来评估TURN评分与90天预后之间的一致性。还将TURN评分与其他6个预测sICH或严重预后的评分进行了比较。
TURN评分预测90天mRS≥5时，OR为5.73，95%置信区间（3.60，9.10），P<0.001，AUROC为0.83，95%置信区间（0.77，0.89）。TURN评分预测90天mRS≤1时，OR为5.24，95%置信区间（3.43，7.99），P<0.001，AUROC为0.80，95%置信区间（0.74，0.85）。TURN评分预测90天mRS≥5时，OR显著高于DRAGON评分（2.30，P = 0.01）、ASTRAL评分（1.18，P<0.001）、HAT评分（2.89，P = 0.05）和SEDAN评分（2.16，P = 0.01），且AUROC显著高于SPAN-100评分（0.64，P<0.001）和SEDAN评分（0.71，P = 0.01）。同样，TURN评分预测90天mRS≤1时，OR显著高于Stroke-TPI评分（2.89，P = 0.05）、DRAGON评分（2.29，P = 0.01）、ASTRAL评分（1.15，P<0.001）、HAT评分（2.71，P = 0.04）和SEDAN评分（2.15，P = 0.01），且AUROC显著高于SPAN-100评分（0.58，P<0.001）和SEDAN评分（0.70，P = 0.01）。使用90天BI评分和90天GOS评分也得到了类似结果。
与几种现有的临床评分相比，TURN评分预测90天预后的准确性相当或更高。
