| BackgroundSymptomatic intracerebral hemorrhage(sICH)is a frightening complication for acute ischemic stroke patients who treated with intravenous(tissue plasminogen activator,rtPA).Acute ischemic stroke complicated with sICH of patients often have poor prognosis and short prognostic survival time.Therefore,it is very important to explore the risk factors for developing sICH after intravenous thrombolysis for acute ischemic stroke.At the same time,early identification and intervention of risk factors can reduce the occurrence of sICH and improve the prognosis of patients.To date,there is a lack of recognized risk assessment tools for sICH at home and abroad.In 2018,Manuel et al.developed STARTINH-SICH Normogram to predict the probability of sICH,which acute ischemic stroke patients after treated with rt-PA intravenous thrombolytic therapy.there has been excellent predictive performance.But the prediction ability of the model in China is unclear.Objectives1.To explore the incidence of sICH in patients who received intravenous thrombolytic therapy with rt-PA for acute ischemic stroke in a third-class A hospital in Lanzhou City;And risk factors for the development of sICH.2.To verify the clinical prediction value of STARTINH-SICH Normogram model in patients who acute ischemic stroke accepted intravenous thrombolytic therapy with rtPA after occurs sICH.MethodsThis study was a retrospective study.In the first part,A total of 223 patients with acute ischemic stroke who received intravenous thrombolysis were included in the study.They were admitted to the emergency green channel of the First Hospital of Lanzhou University from January2019 to July 2022.ECASS-II was used to define the diagnosis of sICH.That is,any type of intracranial hemorrhage with NIHSS score increase ≥4 points from baseline or within death Seven days.The subjects were divided into sICH group and no sICH group.Univariate and binary Logistic regression were used to analyze the clinical data to explore the risk factors of sICH.In the second part,the ability of STARTINH-SICH Normogram to predict sICH was verified in 223 patients with acute ischemic stroke who received intravenous thrombolytic therapy with rt-PA in Lanzhou.Based on the Area under the receiveroperating characteristic curve(AUC-ROC),the discrimination of STARTINH-SICH Normogram model was evaluated by AUC-ROC.Hosmer-Lemeshow(H-L)was used to test the calibration of the model,and the clinical prediction value of STARTINHSICH Normogram was evaluated.Results(1)223 patients with acute ischemic stroke who received intravenous thrombolytic therapy with rt-PA were finally included in this study.sICH occurred in 15 cases(6.7%).The NIHSS score before thrombolysis OR=1.264,[95%CI(1.088-1.468)],the systolic blood pressure before thrombolysis OR=1.145,[95%CI(1.025-1.278)] and the blood glucose before thrombolysis OR=1.285,[95%CI(1.027-1.61)] were sICH Independent risk factors(P≤ 0.05).(2)The AUC-ROC of the STARTING-SICH Normogram was 0.890(95%CI:0.818-0.962).Hosmer-Lemeshow calibration test P = 0.989.The Yoden index was 0.689,and the sum of sensitivity and specificity was the maximum at this time,which was 0.80 and 0.899,respectively.Conclusions(1)In this study,the incidence of sICH in patients with acute ischemic stroke after intravenous thrombolysis with rt-PA was 6.7 %.(2)Pre-thrombolysis NIHSS score,blood glucose and systolic blood pressure are independent risk factors for the occurrence of sICH.pre-thrombolysis NIHSS score,blood glucose and systolic blood pressure may be predictive factors for the occurrence of sICH in AIS patients after intravenous thrombolysis with rt-PA.(3)The STARTING-SICH Normogram predicted the risk differentiation and calibration of sICH in patients with acute ischemic stroke after receiving rt-PA thrombolytic therapy,which may become a clinically practical tool for predicting the occurrence of sICH in patients with AIS after receiving rt-PA thrombolytic therapy in China In the near future. |
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