A novel nomogram to predict hemorrhagic transformation in ischemic stroke patients after intravenous thrombolysis

Abstract

BackgroundHemorrhagic transformation (HT) is the most serious complication of ischemic stroke patients after intravenous thrombolysis and leads to a poor clinical prognosis. This study aimed to determine the independent predictors associated with HT in stroke patients with intravenous thrombolysis and to establish and validate a nomogram that combines with predictors to predict the probability of HT after intravenous thrombolysis in patients with ischemic stroke.MethodThis study enrolled ischemic stroke patients with intravenous thrombolysis from December 2016 to June 2022. All the patients were divided into training and validation cohorts. The nomogram was composed of the significant predictors for HT in the training cohort as obtained by the multivariate logistic regression analysis. The area under the receiver operating characteristic curve was used to assess the discriminative performance of the nomogram. The calibration performance of the nomogram was assessed by the Hosmer–Lemeshow goodness-of-fit test and calibration plots. Decision curve analysis was used to test the clinical validity of the nomogram.ResultsA total of 394 patients with intravenous thrombolysis were enrolled in the study. In the training cohort (n = 257), 45 patients had HT after intravenous thrombolysis. Multivariate logistic regression analysis demonstrated early infarct signs (OR, 7.954; 95% CI, 3.553-17.803; P < 0.001), NIHSS scores (OR, 1.110; 95% CI, 1.054-1.168; P < 0.001), uric acid (OR, 0.993; 95% CI, 0.989–0.997; P = 0.001), and albumin-to-globulin ratio (OR, 0.109; 95% CI, 0.023–0.508; P = 0.005) were independent predictors for HT and constructed the nomogram. In the training and validation cohorts, the AUC of the nomogram was 0.859 and 0.839, respectively. The Hosmer–Lemeshow goodness-of-fit test and calibration plot showed good concordance between predicted and observed probability in the training and validation cohorts. Decision curve analysis indicated that the nomogram was significantly useful for predicting HT in the training and further confirmed in the validation cohort.ConclusionThis study proposes a novel and practical nomogram based on early infarct signs, NIHSS scores, uric acid, and albumin-to-globulin ratio that can well predict the probability of HT after intravenous thrombolysis in patients with ischemic stroke.

Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology

“…8 Of note, those studies were limited by a small sample size 6–8 and low CBI rates (≈20%), 5–7 which was largely different to most recent studies reporting on CBI prevalence in first-ever ischemic stroke patients (37%–46%) and might be attributed to their young patient cohorts. 5–8,10,21 In contrast, we present data of an elderly stroke population (CBI rate: 44%) and were able to report on the effect of CBI for future stroke risk in different etiological stroke subtypes. Although we could not identify an increased risk for stroke recurrence in patients with CBI and LAA-related stroke – possibly influenced by surgical/interventional treatment effects – CBI seem to be strongly associated with recurrent ischemic stroke in patients with cerebral SVD, which was mainly attributed to cavitatory subcortical lesions and multiple CBI.…”

Risk prediction models for intracranial hemorrhage in acute ischemic stroke patients receiving intravenous alteplase treatment: a systematic review

“…PROBAST evaluates the risk of bias and the applicability of the model across four domains: participants, predictors, outcomes, and analysis. three were conducted in multiple countries (12,13,15), six in China (10,(19)(20)(21)(22)(23), two in Italy (17, 18), one in America (14), and one in Thailand (16). Regarding the type of research, one was a prospective cohort study (10), and the others were retrospective.…”

“…three were conducted in multiple countries (12,13,15), six in China (10,(19)(20)(21)(22)(23), two in Italy (17, 18), one in America (14), and one in Thailand (16). Regarding the type of research, one was a prospective cohort study (10), and the others were retrospective. The earliest included publication year was 2008 (12), with four articles published in the past three years (10,(21)(22)(23).…”

“…Regarding the type of research, one was a prospective cohort study (10), and the others were retrospective. The earliest included publication year was 2008 (12), with four articles published in the past three years (10,(21)(22)(23). All studies defined participants as patients treated with alteplase for AIS; six specified participants as 18 years or older (10,17,(20)(21)(22)(23), demonstrating high homogeneity in the studies (Table 1).…”

“…However, its use can lead to complications such as hemorrhage, vascular edema, and seizures (8,9). Intracranial hemorrhage (ICH) is the most severe complication, potentially resulting in prolonged hospital stays, increased medical costs, and a higher likelihood of disability and death (10). The one-year mortality rate associated of ICH patients is reported to be 52.2% (11).…”