The stroke-thrombolytic predictive instrument - A predictive instrument for intravenous thrombolysis in acute ischemic stroke
The stroke-thrombolytic predictive instrument - A predictive instrument for intravenous thrombolysis in acute ischemic stroke
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DOI：
10.1161/01.str.0000249054.96644.c6
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发表时间：
2006-12-01
期刊：
影响因子：
8.3
通讯作者：
Hacke, Werner
中科院分区：
文献类型：
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作者：
Kent, David M.;Selker, Harry P.;Hacke, Werner
背景和目的：许多适合接受重组组织纤溶酶原激活剂（rt-PA）治疗的缺血性卒中患者没有接受治疗，部分原因是治疗医生认为rt-PA治疗的风险和益处。因此，我们的目的是开发一个中风溶栓预测工具（TPI），以帮助医生考虑溶栓治疗中风。（n = 2184）在0- 6小时窗口内检测rt-PA，我们使用临床变量作为良好结局的潜在预测因子，开发了logistic回归方程（改良兰金量表评分= 5），有和无rt-PA。该模型进行了内部验证使用bootstrap re-sampling.Results -为了预测良好的结果，除了rt-PA治疗，7个变量显着影响预后和/或治疗效果的rt-PA：年龄，糖尿病，中风的严重程度，性别，以前的中风，收缩压，和症状发作的时间。预测灾难性结局，只有年龄、卒中严重程度和血糖有意义; rt-PA治疗无意义。对于在3小时内接受治疗的患者，rt-PA组良好结局的中位预测概率为42.9%（四分位距[IQR] = 18.6%-64.7%），而非rt-PA组为25.3%（IQR = 9.8%-46.2%）;中位预测绝对获益为12.5%（IQR = 5.1%-21.0%）。灾难性结局的中位概率（伴或不伴rt-PA）为15.2%（IQR = 8.0%-31.2%）。接受者-操作者特征曲线下的面积为0.788预测良好的结果和0.775预测不良outcome.Conclusions模型-中风TPI预测良好和不良的功能结果与不溶栓。将其纳入可用的工具中，可有助于决策。
Background and Purpose - Many patients with ischemic stroke eligible for recombinant tissue plasminogen activator (rt-PA) are not treated in part because of the risks and benefits perceived by treating physicians. Therefore, we aimed to develop a Stroke-Thrombolytic Predictive Instrument (TPI) to aid physicians considering thrombolysis for stroke.Methods - Using data from 5 major randomized clinical trials (n = 2184) testing rt-PA in the 0- to 6-hour window, we developed logistic regression equations using clinical variables as potential predictors of a good outcome ( modified Rankin Scale score = 5), with and without rt-PA. The models were internally validated using bootstrap re-sampling.Results - To predict good outcome, in addition to rt-PA treatment, 7 variables significantly affected prognosis and/or the treatment-effect of rt-PA: age, diabetes, stroke severity, sex, previous stroke, systolic blood pressure, and time from symptom onset. To predict catastrophic outcome, only age, stroke severity, and serum glucose were significant; rt-PA treatment was not. For patients treated within 3 hours, the median predicted probability of a good outcome with rt-PA was 42.9% (interquartile range [IQR] = 18.6% to 64.7%) versus 25.3% (IQR = 9.8% to 46.2%) without rt-PA; the median predicted absolute benefit was 12.5% (IQR = 5.1% to 21.0%). The median probability for a catastrophic outcome, with or without, rt-PA was 15.2% (IQR = 8.0% to 31.2%). The area under the receiver-operator characteristic curve was 0.788 for the model predicting good outcome and 0.775 for the model predicting bad outcome.Conclusions - The Stroke-TPI predicts good and bad functional outcomes with and without thrombolysis. Incorporated into a usable tool, it may assist in decision-making.