Comparison of Risk-scoring Systems in Predicting Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis

Abstract

Background and Purpose— Various risk score models have been developed to predict symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis for acute ischemic stroke. In this study, we aimed to determine the prediction performance of these risk scores in a Taiwanese population Methods— Prospectively collected data from 4 hospitals were used to calculate probability of SICH with the scores developed by Cucchiara et al, the Hemorrhage After Thrombolysis (HAT) score, the Safe Implementation of Thrombolysis in Stroke-SICH risk score, the Glucose Race Age Sex Pressure Stroke Severity score, and the Stroke Prognostication using Age and National Institutes of Health Stroke Scale-100 index. We used logistic regression to evaluate the effectiveness of each risk model in predicting SICH and the c statistic to assess performance. Results— A total of 548 patients were included. The rates of SICH were 7.3% by the National Institute of Neurological Diseases and Stroke definition, 5.3% by the European-Australasian Cooperative Acute Stroke Study II definition, and 3.5% by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study definition. The Cucchiara score, the HAT score, and the Safe Implementation of Thrombolysis in Stroke-SICH risk score were significant predictors of SICH for all 3 definitions, whereas the Glucose Race Age Sex Pressure Stroke Severity score and the Stroke Prognostication using Age and National Institutes of Health Stroke Scale-100 index predicted well only for 1 or 2 definitions of SICH. The c statistic was highest for the HAT score (range, 0.69–0.73) across the definitions of SICH. Conclusions— The Cucchiara score, the HAT score, and the Safe Implementation of Thrombolysis in Stroke-SICH risk score predicted SICH reasonably well regardless of which SICH definition was used. However, only the HAT score had an acceptable discriminatory ability.

Symptomatic Intracranial Hemorrhage After Stroke Thrombolysis

“…Sung et al 14 recently compared sICH scores. However, that study was rather small (n=548) and excluded SEDAN because of unavailability of imaging data in their database.…”

“…The only difference was the worse performance by GRASPS in Sung et al's study. 14 This was perhaps because of including exclusively patients of Asian race, which was identified as a strong predictor of sICH in the GRASPS model. Last but not least, the dose of tissue plasminogen activator ranged from 0.6 to 0.9 mg/kg according to the Taiwan guidelines.…”

Hemorrhagic Transformation after Ischemic Stroke in Animals and Humans

“…Though each score is able to identify patients at increased risk of HT, they do not achieve sufficient sensitivity or specificity to withhold tPA in otherwise tPA eligible patients. 171 Thus, additional predictors to stratify risk of HT after ischemic stroke have been sought, including neuroimaging and blood biomarkers. Several brain imaging approaches have been evaluated to predict HT after stroke (Table 1).…”

Predicting Functional Outcome and Symptomatic Intracranial Hemorrhage in Patients With Acute Ischemic Stroke

“…[2][3][4] This review summarizes current prognostic scores, discusses the scientific background behind the scores' main components, acknowledges their strengths and limitations, and highlights the areas which warrant further research. Because of the space limitations, scores which were initially developed for one outcome (eg, functional outcome) and were later validated also for other outcomes (eg, post-thrombolytic sICH) will be discussed only for the initially validated outcome.…”