title: Patient outcomes from symptomatic intracerebral hemorrhage after stroke thrombolysis.
abstract: OBJECTIVE
  To assess the impact of symptomatic intracerebral hemorrhage (sICH) on outcome of thrombolysis-treated ischemic stroke patients, as additional to recognized prognosticators.
  
  
  METHODS
  The study cohort included 985 ischemic stroke patients treated with IV thrombolysis at the Helsinki University Central Hospital (1995-2008). In a multivariable model adjusted for baseline stroke severity, age, onset-to-treatment time, baseline glucose, hyperdense cerebral artery sign, and early infarct signs on baseline imaging, and prior modified Rankin Scale (mRS), we calculated risk ratios (RRs) of patients with sICH (separately per Safe Implementation of Thrombolysis in Stroke[SITS]-Monitoring Study, European Cooperative Acute Stroke Study II [ECASS-II], and National Institute of Neurological Disorders and Stroke [NINDS] definitions) for poor 3-month outcome (mRS 3-6) and mortality. Receiver operating characteristic (ROC) curve and integrated discrimination improvement (IDI) evaluated impact of sICH on outcome. Internal cross-validation of the model was done with bootstrap statistics.
  
  
  RESULTS
  The frequency of sICH was 2.1% (SITS), 7.0% (ECASS-II), and 9.4% (NINDS). RRs for poor and fatal outcome, respectively, were 1.7 and 4.8 (SITS), 1.6 and 3.8 (ECASS-II), and 1.6 and 3.4 (NINDS). In IDI analyses, sICH improved prediction model for 3-month mRS of 3-6 and 4-6, respectively, by 1.4% and 3.0% (SITS), 4.0% and 5.9% (ECASS-II), and 4.7% and 6.1% (NINDS). In case of 3-month mRS 5-6 and mortality, it was 6.1% and 5.3% (SITS), 11.3% and 9.3% (ECASS-II), and 10.3% and 8.0% (NINDS). ROC analysis revealed similar results.
  
  
  CONCLUSIONS
  Patients with sICH have increased risk of poor and fatal outcome. Compared with recognized stroke prognosticators, contribution of sICH is smaller. Definition-wise, ECASS-II- and NINDS-based sICH contribute relatively more; ECASS-II has the largest contribution to worst outcomes.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. daniel.strbian@hus.fi
authors.forename: D
authors.initials: D
authors.lastname: Strbian
authors.forename: T
authors.initials: T
authors.lastname: Sairanen
authors.forename: A
authors.initials: A
authors.lastname: Meretoja
authors.forename: J
authors.initials: J
authors.lastname: Pitkäniemi
authors.forename: J
authors.initials: J
authors.lastname: Putaala
authors.forename: O
authors.initials: O
authors.lastname: Salonen
authors.forename: H
authors.initials: H
authors.lastname: Silvennoinen
authors.forename: M
authors.initials: M
authors.lastname: Kaste
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D015233:Models, Statistical; D016017:Odds Ratio; D012372:ROC Curve; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D009626:Terminology as Topic; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator