The SONA score: A novel grading scale for predicting hemorrhage and outcomes after thrombolysis.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.