Clinical Study On Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator

Objective:To assess the performance of SEDAN、SITS-SICH、GRASPS、MSS, and SPAN-100 scores in predicting symptomatic intracranial hemorrhage(SICH) after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA). Methods: A multicenter prospective study was performed in 811 patients who underwent intravenous thrombolysis(IVT) with standard-dose recombinant tissue plasminogen activator within 4.5 hours of acute ischemic stroke(AIS) onset in 67 stroke centers involved in the Thrombolysis Implementation and Monitor of acute ischemic Stroke in China(TIMS-China) program from May 2007 to April 2012. SEDAN(blood sugar, early infarct signs, [hyper]dense cerebral artery sign, age, NIH Stroke Scale), SITS-SICH(Safe Implementation of Thrombolysis in Stroke-SICH), GRASPS(glucose at presentation, race[Asian], age, sex[male], systolic blood pressure at presentation), MSS(Multicenter Stroke Survey), and SPAN(stroke prognostication using age and NIH Stroke Scale)-100 scores were calculated in selected patients and their predictive performance for SICH was compared according to the NINDS, SITS-SICH, and ECASS-II criteria. Results: 811 AIS patients undergoing IVT that met the inclusion criteria were consecutively enrolled. For predicting the risk of SICH(NINDS definition) after IVT, the area under the receiver operating characteristic(AUC-ROC) curve of SEDAN, SITS-SICH, GRASPS, MSS, and SPAN-100 scores was 0.59(95%CI 0.51-0.67), 0.65(95%CI 0.56-0.75), 0.70(95%CI 0.60-0.79), 0.71(95%CI 0.62-0.80) and 0.51(95%CI 0.50-0.51) respectively. For predicting the risk of SICH(SITS-MOST definition) after IVT, the AUC-ROC curve was 0.59(95%CI 0.49-0.69) 、 0.69(95%CI 0.55-0.84) 、0.73(95%CI 0.61-0.84)、0.72(95%CI 0.60-0.84) and 0.51(95%CI 0.50-0.51) respectively. For predicting SICH(ECASS-II definition) after IVT, the AUC-ROC curve was 0.62(95%CI 0.53-0.71), 0.72(95%CI 0.62-0.83), 0.70(95%CI 0.59-0.80), 0.73(95%CI 0.63-0.83), 0.51(95%CI 0.50-0.51) respectively. Conclusions: SITS-SICH, GRASPS, and MSS scores predicted the risk of SICH after IVT in patients with AIS, but only the latter two were better in the Chinese population. MSS score had the best predictive performance for SICH using NINDS and ECASS-II definitions, whereas GRASPS score was best for SICH using the SITS-MOST definition.