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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models
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Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models

机译：静脉溶栓后症状脑出血：预测因素和预测模型的验证

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Objective: Thrombolytic therapy with intravenous alteplase (IV-rtPA) has a known risk of symptomatic intracerebral hemorrhage (sICH). We aim to identify factors with a significant association with the development of sICH post-IV-rtPA. We also aim to perform an external validation of sICH predicting scores in our patient population. Material and Methods: We performed a retrospective chart review of patients who received IV-rtPA at our tertiary care hospital. We excluded patients who underwent mechanical thrombectomy. We analyzed various factors recorded at presentation such as presenting mean arterial pressure (MAP), blood glucose, National Institutes of Health Stroke Scale (NIHSS) score, verify Aspirin, verify Plavix, age, sex, platelet count, international normalized ratio, prothrombin time, partial thromboplastin time, hemoglobin A1c, low-density lipoprotein, onset to treatment time, weight, sex, and early infarct signs on computed tomography (CT) head and compared them between sICH and non-sICH groups. For validation of sICH scores, we used documented variables to calculate the following scores for each patient: stroke prognostication using age and NIH stroke scale-100 (SPAN-100), DRAGON, CUCCHIARA, hemorrhage after thrombolysis (HAT), SEDAN, totaled health risks in vascular events, and safe implementation of thrombolysis in stroke-symptomatic intracerebral hemorrhage. Results: sICH rate in our cohort of 89 patients was 5.62% according to the European-Australasian Cooperative Acute Stroke Study-II (ECASS-II) criteria and 7.86% according to the National Institute of Neurological Disorders and Stroke (NINDS) criteria. In the multivariate regression analysis, MAP (95% CI, .001-.01; P. 002), blood glucose greater than or equal to 185 mg/dL (95% CI, .12-.45; P. 001) and presence of early infarct signs (95% CI, .06-.25; P. 002) had a significant association with the development of sICH with the ECASS-II definition of sICH post-IV-rtPA, whereas, only MAP (95% CI, 1.01-1.18; P. 025) and verify Aspirin less than 500 (95% CI, .01-.80; P. 032) had a significant association with the development of sICH with the NINDS definition of sICH post-IV-rtPA. Our study found that HAT (95% CI, .58-.96; P. 044) and DRAGON (95% CI, .61-.96; P. 012) scores had the highest area under the curve (AUC) with respect to ECASS-II and NINDS criteria of sICH, respectively. Conclusions: We found that presenting MAP, presence of early infarct signs on CT Head and blood glucose greater than or equal to 185 mg/dL upon a patient's presentation have a significant association with sICH post-IV-rtPA when the ECASS-II definition was used, while presenting MAP and verify Aspirin less than 500 upon a patient's presentation have a significant association with sICH post-IV-rtPA when the NINDS definition was used. Our study found that HAT and DRAGON scores had the highest AUC, and they were the most valid in predicting the development of sICH in our independent cohort. Patients with these risk factors should receive more intensive neurological monitoring.
机译：目的：用静脉内甲基（IV-RTPA）溶栓治疗（IV-RTPA）具有已知的症状脑出血（SICH）的风险。我们的目标是识别与SICH后IV-RTPA的发展有关的因素。我们还旨在对我们的患者人口中的SICH进行外部验证。材料与方法：我们对在我们的第三关节医院接受了IV-RTPA的患者进行了回顾性图表综述。我们排除了接受机械血栓切除术的患者。我们分析了在介绍中记录的各种因素，如呈递平均动脉压（MAP），血糖，国家卫生卒中量表（NIHSS）得分，验证阿司匹林，核实素，年龄，性别，血小板计数，国际归一化比例，凝血酶原时间，部分血栓形成时间，血红蛋白A1c，低密度脂蛋白，发病于治疗时间，重量，性别和早期梗塞在计算机断层扫描（CT）头上并与SICH和非SICH组之间进行比较。为了验证SICH分数，我们使用记录的变量来计算每位患者的以下分数：使用年龄和NIH中风级别-100（SPAN-100），龙，CUCCHIARA，出血（帽子），轿车（帽子），轿车总共患者的卒中预后血管事件中的风险，安全地实施中风症状脑出血的溶栓。结果：根据欧洲澳大利亚合作急性中风研究-II（ECASS-II）标准，我们的队列队列的队列率为8.62％，根据国家神经障碍和中风（NINDS）标准，7.86％。在多元回归分析中，地图（95％CI，.001-.01; P.002），血糖大于或等于185mg / dl（95％CI，.12-.45; P. 001）和早期梗死标志的存在（95％CI，.06-.25; P. 002）与SICH的发展与SICH-II-RTPA的ECASS-II定义有重大关联，而只有地图（95％） CI，1.01-1.18; p.025）并验证阿司匹林小于500（95％CI，0.01-.80;第032页）与SICH的发展与SICH后IV后IV的NINDS定义有关rtpa。我们的研究发现，帽子（95％CI，0.58-.96;第044页）和Dragon（95％CI，.61-.96;第012页）得分在曲线（AUC）下具有最高面积澳索-II分别与SICH的NINDS标准。结论：在患者介绍时，呈现地图，患者患者的早期梗死和血糖的存在大于或等于185mg / dL的血糖符号与SICH-II-RTPA有显着关系使用的同时呈现地图并在患者的介绍时验证患者患者的少于500的阿司匹林与SICH后IV-RTPA有显着关系，当使用NINDS定义时。我们的研究发现，帽子和龙家得分具有最高的AUC，它们在预测我们独立的队列中最有效的是Sich的发展。这些风险因素的患者应接受更密集的神经系统监测。

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