The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke.
The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke.
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DOI：
10.1186/s12883-017-0958-3
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发表时间：
2017-09-07
期刊：
影响因子：
2.6
通讯作者：
Ibatullin MM
中科院分区：
文献类型：
--
作者：
Kalinin MN;Khasanova DR;Ibatullin MM
我们的目的是开发一种工具，出血性转化（HT）指数（HTI），以预测大脑中动脉（MCA）卒中发作后14天内的任何HT，无论静脉重组组织纤溶酶原激活剂（IV rtPA）的使用。鉴于缺乏关于房颤（AF）患者卒中后恢复抗凝时间的循证数据，这一点尤为重要。我们回顾性分析了783例连续MCA卒中患者。记录入院时的临床和脑成像数据。随访期为入院后2周。通过生成概率参数为0.7的伯努利变量，将患者分为推导（DC）和验证（VC）队列。单因素/多因素Logistic回归和因素分析被用来提取独立的预测因素。采用内部一致性信度和受试者工作特征（ROC）分析进行验证。Bootstrapping用于减少偏倚。HTI包括4个项目：阿尔伯塔卒中项目早期CT评分（ASPECTS）、美国国立卫生研究院卒中量表（NIHSS）、MCA高密度征（HMCA）和入院时心电图（ECG）上的AF。根据预测概率（PP）范围，ASPECTS评分分配如下：10-7 = 0; 6-5 = 1; 4-3 = 2; 2-0 = 3; NIHSS：0-11 = 0; 12-17 = 1; 18-23 = 2; >23 = 3; HMCA体征：是= 1;心电图上的AF：是= 1。HTI评分从0到8不等。对于每个评分，任何HT的校正PP和95%置信区间（CI）如下：0 = 0.027（0.011-0.042）; 1 = 0.07（0.043-0.098）; 2 = 0.169（0.125-0.213）; 3 = 0.346（0.275-0.417）; 4 = 0.571（0.474-0.668）; 5 = 0.768（0.676-0.861）; 6 = 0.893（0.829-0.957）; 7 = 0.956（0.92-0.992）; 8 = 0.983（0.965-1.0）。对于DC和VC，区分HT阳性组和阴性组的最佳临界点评分为2（95%基于正常值的CI，1-3）。DC和VC的ROC面积/灵敏度/特异度及95%正常值CI分别为0.85（0.82-0.89）/0.82（0.73-0.9）/0.89（0.8-0.97）和0.83（0.78-0.88）/0.8（0.66-0.94）/0.87（0.73-1.0）。DC和VC的McDonald分类Ω和95%偏倚校正和加速CI分别为0.81（0.77-0.84）和0.82（0.76-0.86）。HTI是预测MCA卒中发作后2周内任何HT的简单而可靠的工具，无论是否使用IV rtPA。
We aimed to develop a tool, the hemorrhagic transformation (HT) index (HTI), to predict any HT within 14 days after middle cerebral artery (MCA) stroke onset regardless of the intravenous recombinant tissue plasminogen activator (IV rtPA) use. That is especially important in the light of missing evidence-based data concerning the timing of anticoagulant resumption after stroke in patients with atrial fibrillation (AF). We retrospectively analyzed 783 consecutive MCA stroke patients. Clinical and brain imaging data at admission were recorded. A follow-up period was 2 weeks after admission. The patients were divided into derivation (DC) and validation (VC) cohorts by generating Bernoulli variates with probability parameter 0.7. Univariate/multivariate logistic regression, and factor analysis were used to extract independent predictors. Validation was performed with internal consistency reliability and receiver operating characteristic (ROC) analysis. Bootstrapping was used to reduce bias. The HTI was composed of 4 items: Alberta Stroke Program Early CT score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), hyperdense MCA (HMCA) sign, and AF on electrocardiogram (ECG) at admission. According to the predicted probability (PP) range, scores were allocated to ASPECTS as follows: 10–7 = 0; 6–5 = 1; 4–3 = 2; 2–0 = 3; to NIHSS: 0–11 = 0; 12–17 = 1; 18–23 = 2; >23 = 3; to HMCA sign: yes = 1; to AF on ECG: yes = 1. The HTI score varied from 0 to 8. For each score, adjusted PP of any HT with 95% confidence intervals (CI) was as follows: 0 = 0.027 (0.011–0.042); 1 = 0.07 (0.043–0.098); 2 = 0.169 (0.125–0.213); 3 = 0.346 (0.275–0.417); 4 = 0.571 (0.474–0.668); 5 = 0.768 (0.676–0.861); 6 = 0.893 (0.829–0.957); 7 = 0.956 (0.92–0.992); 8 = 0.983 (0.965–1.0). The optimal cutpoint score to differentiate between HT-positive and negative groups was 2 (95% normal-based CI, 1–3) for the DC and VC alike. ROC area/sensitivity/specificity with 95% normal-based CI for the DC and VC were 0.85 (0.82–0.89)/0.82 (0.73–0.9)/0.89 (0.8–0.97) and 0.83 (0.78–0.88)/0.8 (0.66–0.94)/0.87 (0.73–1.0) respectively. McDonald’s categorical omega with 95% bias-corrected and accelerated CI for the DC and VC was 0.81 (0.77–0.84) and 0.82 (0.76–0.86) respectively. The HTI is a simple yet reliable tool to predict any HT within 2 weeks after MCA stroke onset regardless of the IV rtPA use.
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影响因子：
2.9
作者：
Koo, CK;Teasdale, E;Muir, KW
通讯作者：
Muir, KW
影响因子：
8.3
作者：
Paciaroni, Maurizio;Agnelli, Giancarlo;Silvestrelli, Giorgio
通讯作者：
Silvestrelli, Giorgio
影响因子：
2.9
作者：
Demchuk, Andrew M.;Khan, Firosh;Levine, Steven R.
通讯作者：
Levine, Steven R.
影响因子：
8.3
作者：
Fiorelli, M;Bastianello, S;Bozzao, L
通讯作者：
Bozzao, L
DOI：
10.1016/j.jstrokecerebrovasdis.2008.03.003
发表时间：
2008-09-01
期刊：
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
影响因子：
--
作者：
Pundik, Svetlna;McWilliams-Dunnigan, Laurie;Suarez, Jose I
通讯作者：
Suarez, Jose I