Symptomatic intracranial hemorrhage after stroke thrombolysis: comparison of prediction scores.
OBJECTIVE
Several prognostic scores have been developed to predict the risk of symptomatic intracranial hemorrhage (sICH) after ischemic stroke thrombolysis. We compared the performance of these scores in a multicenter cohort.


METHODS
We merged prospectively collected data of patients with consecutive ischemic stroke who received intravenous thrombolysis in 7 stroke centers. We identified and evaluated 6 scores that can provide an estimate of the risk of sICH in hyperacute settings: MSS (Multicenter Stroke Survey); HAT (Hemorrhage After Thrombolysis); SEDAN (blood sugar, early infarct signs, [hyper]dense cerebral artery sign, age, NIH Stroke Scale); GRASPS (glucose at presentation, race [Asian], age, sex [male], systolic blood pressure at presentation, and severity of stroke at presentation [NIH Stroke Scale]); SITS (Safe Implementation of Thrombolysis in Stroke); and SPAN (stroke prognostication using age and NIH Stroke Scale)-100 positive index. We included only patients with available variables for all scores. We calculated the area under the receiver operating characteristic curve (AUC-ROC) and also performed logistic regression and the Hosmer-Lemeshow test.


RESULTS
The final cohort comprised 3012 eligible patients, of whom 221 (7.3%) had sICH per National Institute of Neurological Disorders and Stroke, 141 (4.7%) per European Cooperative Acute Stroke Study II, and 86 (2.9%) per Safe Implementation of Thrombolysis in Stroke criteria. The performance of the scores assessed with AUC-ROC for predicting European Cooperative Acute Stroke Study II sICH was: MSS, 0.63 (95% confidence interval, 0.58-0.68); HAT, 0.65 (0.60-0.70); SEDAN, 0.70 (0.66-0.73); GRASPS, 0.67 (0.62-0.72); SITS, 0.64 (0.59-0.69); and SPAN-100 positive index, 0.56 (0.50-0.61). SEDAN had significantly higher AUC-ROC values compared with all other scores, except for GRASPS where the difference was nonsignificant. SPAN-100 performed significantly worse compared with other scores. The discriminative ranking of the scores was the same for the National Institute of Neurological Disorders and Stroke, and Safe Implementation of Thrombolysis in Stroke definitions, with SEDAN performing best, GRASPS second, and SPAN-100 worst.


CONCLUSIONS
SPAN-100 had the worst predictive power, and SEDAN constantly the highest predictive power. However, none of the scores had better than moderate performance.
From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville, Australia (A.M., S.M.D.); University Lille Nord de France, Lille, France (K.M., C.C.); and Kantonsspital St Gallen, St Gallen, Switzerland (B.W.).
Daniel
D
Strbian
Patrik
P
Michel
David J
DJ
Seiffge
Jeffrey L
JL
Saver
Heikki
H
Numminen
Atte
A
Meretoja
Kei
K
Murao
Bruno
B
Weder
Nina
N
Forss
Anna-Kaisa
AK
Parkkila
Ashraf
A
Eskandari
Charlotte
C
Cordonnier
Stephen M
SM
Davis
Stefan T
ST
Engelter
Turgut
T
Tatlisumak
D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects
D010959:Tissue Plasminogen Activator
intracranial hemorrhages