Ren Yu, He Zhongxiang, Du Xiaoyan, Liu Jie, Zhou Li, Bai Xue, Chen Yue, Wu Bowen, Song Xiaosong, Zhao Libo, Yang Qin
Department of Neurology, Nanchong Central Hospital, Sichuan, China.
Health Manage Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2022 Oct 31;13:952843. doi: 10.3389/fneur.2022.952843. eCollection 2022.
This study aimed to develop a score including novel putative predictors for predicting the risk of sICH and outcomes after thrombolytic therapy with intravenous (IV) recombinant tissue-type plasminogen activator (r-tPA) in acute ischemic stroke patients.
All patients with acute ischemic stroke treated with IV r-tPA at three university-based hospitals in Chongqing, China, from 2014 to 2019 were retrospectively studied. Potential risk factors associated with sICH (NINDS criteria) were determined with multivariate logistic regression, and we developed our score according to the magnitude of logistic regression coefficients. The score was validated in another independent cohort. Area under the receiver operating characteristic curve (AUC-ROC) was used to assess the performance of the score. Calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit method.
The SONA score (0 to 8 points) consisted of history of moking (no = 1, yes = 0, β = 0.81), nset-to-needle time (≥3.5 = 1,<3.5=0, β = 0.74), IH Stroke Scale on admission (>10 = 2, ≤10 = 0, β = 1.22), eutrophil percentage (≥80.0% = 1, <80% = 0, β = 0.81), SPECT score (≤11 = 2, >11 = 0, β = 1.30), and ge (>65 years = 1, ≤65 years = 0, β = 0.89). The SONA score was strongly associated with sICH (OR 1.98; 95%CI 1.675-2.34) and poor outcomes (OR 1.89; 95%CI 1.68-2.13). AUC-ROC in the derivation cohort was 0.82 (95%CI 0.77-0.86). Similar results were obtained in the validation cohort. The Hosmer-Lemeshow test revealed that predicted and observed event rates in derivation and validation cohorts were very close.
The SONA score is a simple, efficient, quick, and easy-to-perform scale for predicting the risk of sICH and outcome after intravenous r-tPA thrombolysis within 4.5 h in patients with ischemic stroke, and risk assessment using this test has the potential for early and personalized management of this disease in high-risk patients.
本研究旨在开发一种包含新型潜在预测指标的评分系统，用于预测急性缺血性脑卒中患者静脉注射重组组织型纤溶酶原激活剂（r-tPA）后发生症状性颅内出血（sICH）的风险及溶栓治疗后的结局。
对2014年至2019年在中国重庆三家大学附属医院接受静脉r-tPA治疗的所有急性缺血性脑卒中患者进行回顾性研究。通过多因素逻辑回归确定与sICH（美国国立神经疾病与卒中研究所标准）相关的潜在危险因素，并根据逻辑回归系数的大小制定我们的评分系统。该评分系统在另一个独立队列中进行验证。采用受试者工作特征曲线下面积（AUC-ROC）评估评分系统的性能。使用Hosmer-Lemeshow拟合优度法评估校准情况。
SONA评分（0至8分）包括吸烟史（无=1，有=0，β=0.81）、发病至穿刺时间（≥3.5小时=1，<3.5小时=0，β=0.74）、入院时美国国立卫生研究院卒中量表评分（>10分=2，≤10分=0，β=1.22）、中性粒细胞百分比（≥80.0%=1，<80%=0，β=0.81）、单光子发射计算机断层扫描（SPECT）评分（≤11分=2，>11分=0，β=1.30）以及年龄（>65岁=1，≤65岁=0，β=0.89）。SONA评分与sICH（比值比[OR]1.98；95%置信区间[CI]1.675 - 2.34）和不良结局（OR 1.89；95%CI 1.68 - 2.13）密切相关。推导队列中的AUC-ROC为0.82（95%CI 0.77 - 0.86）。在验证队列中获得了类似结果。Hosmer-Lemeshow检验显示，推导队列和验证队列中预测事件率与观察事件率非常接近。
SONA评分是一种简单、有效、快速且易于实施的量表，用于预测缺血性脑卒中患者在4.5小时内静脉注射r-tPA后发生sICH的风险及结局，使用该检测进行风险评估有可能对高危患者进行该疾病的早期和个性化管理。
