Wei Chenchen, Liu Junfeng, Guo Wen, Jin Yuxi, Song Quhong, Wang Yanan, Ye Chen, Li Jing, Zhang Shanshan, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Neurol. 2021 Nov 15;12:747026. doi: 10.3389/fneur.2021.747026. eCollection 2021.
Hemorrhagic transformation (HT) after reperfusion therapy for acute ischemic stroke (AIS) has been well studied; however, there is scarce research focusing on spontaneous HT (sHT). Spontaneous HT is no less important with a relatively high incidence and could be associated with neurological worsening. We aimed to develop and validate a simple and practical model to predict sHT after AIS (SHAIS) and compared the predictive value of the SHAIS score against the models of post-Reperfusion HT for sHT. Patients with AIS admitted within 24 h of onset were prospectively screened to develop and validate the SHAIS score. The primary outcome was sHT during hospitalization (within 30 days after onset), and the secondary outcomes were symptomatic sHT and parenchymal hematoma (PH). Clinical information, laboratory, and neuroimaging data were screened to construct the SHAIS score. We selected six commonly used scales for predicting HT after reperfusion therapy and compared their predictive ability for sHT with the SHAIS score using Delong's test. The derivation cohort included 539 patients (mean age, 68.1 years; men, 61.4%), of whom 91 (16.9%) patients developed sHT with 25.3% (23/91) being symptomatic sHT and 62.6% (57/91) being PH. Five variables (atrial fibrillation, NIHSS score ≥ 10, hypodensity > 1/3 of middle cerebral artery territory, hyperdense artery sign, and anterior circulation infarction) composed the SHAIS score, which ranged from 0 to 11 points. The area under the receiver-operating characteristic curve (AUC) was 0.86 (95% CI 0.82-0.91, < 0.001) for the overall sHT, 0.85 (95% CI 0.76-0.92, < 0.001) for symptomatic sHT, and 0.89 (95% CI 0.85-0.94, < 0.001) for PH. No evidence of miscalibration of the SHAIS score was found to predict the overall sHT ( = 0.19), symptomatic sHT ( = 0.44), and PH ( = 0.22). The internal ( = 245) and external validation cohorts ( = 200) depicted similar predictive performance compared to the derivation cohort. The SHAIS score had a higher AUC to predict sHT than any of the six pre-Existing models ( < 0.05). The SHAIS score provides an easy-to-use model to predict sHT, which could help providers with decision-making about treatments with high bleeding risk, and to counsel patients and families on the baseline risk of HT, aligning expectations with probable outcomes.
急性缺血性卒中（AIS）再灌注治疗后的出血性转化（HT）已得到充分研究；然而，针对自发性HT（sHT）的研究却很少。自发性HT发病率相对较高，同样重要，且可能与神经功能恶化相关。我们旨在开发并验证一个简单实用的模型来预测AIS后的sHT（SHAIS），并将SHAIS评分的预测价值与再灌注后HT模型对sHT的预测价值进行比较。对发病24小时内入院的AIS患者进行前瞻性筛查，以开发并验证SHAIS评分。主要结局是住院期间（发病后30天内）的sHT，次要结局是有症状的sHT和脑实质血肿（PH）。筛选临床信息、实验室及神经影像数据以构建SHAIS评分。我们选择了六个常用的再灌注治疗后预测HT的量表，并使用德龙检验将它们对sHT的预测能力与SHAIS评分进行比较。推导队列包括539例患者（平均年龄68.1岁；男性占61.4%），其中91例（16.9%）发生sHT，25.3%（23/91）为有症状的sHT，62.6%（57/91）为PH。五个变量（心房颤动、美国国立卫生研究院卒中量表（NIHSS）评分≥10、低密度影>大脑中动脉供血区的1/3、高密度动脉征和前循环梗死）构成了SHAIS评分，范围为0至11分。总体sHT的受试者工作特征曲线（ROC）下面积（AUC）为0.86（95%CI 0.82 - 0.91，P<0.001），有症状sHT的AUC为0.85（95%CI 0.76 - 0.92，P<0.001），PH的AUC为0.89（95%CI 0.85 - 0.94，P<0.001）。未发现SHAIS评分预测总体sHT（P = 0.19）、有症状sHT（P = 0.44）和PH（P = 0.22）存在校准错误的证据。与推导队列相比，内部验证队列（n = 245）和外部验证队列（n = 200）表现出相似的预测性能。SHAIS评分预测sHT的AUC高于六个现有模型中的任何一个（P<0.05）。SHAIS评分提供了一个易于使用的模型来预测sHT，这有助于医疗人员对高出血风险治疗进行决策，并就HT的基线风险向患者及其家属提供咨询，使期望与可能的结果相一致。
