Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
Clin Neurol Neurosurg. 2024 Oct;245:108500. doi: 10.1016/j.clineuro.2024.108500. Epub 2024 Aug 6.
This study aimed to externally validate different predictive scores for symptomatic intracranial hemorrhage (SICH) after intravenous thrombolysis (IVT), with a particular focus on their predictive abilities in Asian stroke patients.
We retrospectively enrolled stroke patients who received a standard dose of alteplase within 4.5 hours from symptom onset at the First Affiliated Hospital of Dalian Medical University from July 2010 to August 2023. SICH was defined as the hemorrhagic transformation detected on the head CT scan completed within 48 h post-IVT, accompanied by a clinical deterioration of at least a 4-point increase in NIHSS score. Predictive abilities of the HAT, MSS, SEDAN, SPAN-100, and GRASPS scores were tested. Discrimination and calibration were performed using the area under the receiver operating characteristic curve (ROC-AUC), DeLong test, and Hosmer-Lemeshow (H-L) goodness-of-fit test.
The study included 1007 stroke patients, of whom 31 (3.08 %) developed SICH. ROC-AUCs for predicting SICH were: 0.796 (95 %CI: 0.726-0.866) for the GRASPS score, 0.724 (95 %CI: 0.644-0.804) for the MSS score, 0.715 (95 %CI: 0.619-0.811) for the SEDAN score, 0.714 (95 %CI: 0.611-0.817) for the HAT score, and 0.605 (95 %CI: 0.491-0.720) for the SPAN-100 score (all P < 0.05). DeLong tests showed that the GRASPS score demonstrated significantly better discrimination than the MSS score (P = 0.010), the SEDAN score (P = 0.009), the HAT score (P = 0.049), and the SPAN-100 score (P = 0.000). H-L tests indicated good calibrations which were ranked HAT > SEDAN > MSS > SPAN-100 > GRASPS scores.
The GRASPS score showed reasonable predictive ability for SICH, indicating its potential utility for Asian stroke patients receiving IVT.
本研究旨在对静脉溶栓（IVT）后症状性颅内出血（SICH）的不同预测评分进行外部验证，尤其关注它们在亚洲卒中患者中的预测能力。
我们回顾性纳入了 2010 年 7 月至 2023 年 8 月在大连医科大学附属第一医院接受标准剂量阿替普酶 IVT 的发病 4.5 小时内的卒中患者。SICH 定义为 IVT 后 48 小时内完成的头部 CT 扫描显示出血性转化，伴有 NIHSS 评分至少增加 4 分的临床恶化。测试 HAT、MSS、SEDAN、SPAN-100 和 GRASPS 评分的预测能力。使用接受者操作特征曲线（ROC-AUC）下面积、DeLong 检验和 Hosmer-Lemeshow（H-L）拟合优度检验进行区分度和校准度评估。
研究纳入了 1007 例卒中患者，其中 31 例（3.08%）发生了 SICH。预测 SICH 的 ROC-AUC 为：GRASPS 评分 0.796（95%CI：0.726-0.866），MSS 评分 0.724（95%CI：0.644-0.804），SEDAN 评分 0.715（95%CI：0.619-0.811），HAT 评分 0.714（95%CI：0.611-0.817），SPAN-100 评分 0.605（95%CI：0.491-0.720）（均 P<0.05）。DeLong 检验显示，GRASPS 评分的区分度明显优于 MSS 评分（P=0.010）、SEDAN 评分（P=0.009）、HAT 评分（P=0.049）和 SPAN-100 评分（P=0.000）。H-L 检验表明，校准度良好，HAT 评分>HSEDAN 评分>MSS 评分>SPAN-100 评分>GRASPS 评分。
GRASPS 评分对 SICH 具有较好的预测能力，表明其对接受 IVT 的亚洲卒中患者具有潜在的应用价值。
