A Nomogram to Predict Symptomatic Intracranial Hemorrhage After Intravenous Thrombolysis in Chinese Patients

Abstract

Hongquan Guo,1,* Wei Xu,1,2,* Xiaohao Zhang,3,* Shuai Zhang,4 Zheng Dai,5 Shun Li,6 Yi Xie,3 Yingle Li,1 Jianzhong Xue,7 Xinfeng Liu1 1Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu, 210002, People’s Republic of China; 2Department of Neurology, Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, 410000, People’s Republic of China; 3Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People’s Republic of China; 4Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225001, People’s Republic of China; 5Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, 214023, People’s Republic of China; 6Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210002, People’s Republic of China; 7Department of Neurology, Changshu No.2 People’s Hospital, Changshu, Jiangsu, 215500, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinfeng LiuDepartment of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] XueDepartment of Neurology, Changshu No.2 People’s Hospital, No. 18 Taishan Road, Changshu, Jiangsu Province, People’s Republic of ChinaTel [phone]Email [email protected] and Aims: A reliable predictive score system to identify the risk of symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis (IVT) in acute ischemic stroke patients is of great essence. We aimed to develop a nomogram for predicting the risk of sICH after IVT in Chinese patients.Methods: We recruited acute ischemic stroke patients who were treated with IVT from five advanced stroke centers in China from April 2014 to November 2020. sICH was diagnosed according to the European Cooperative Acute Stroke Study II (ECASS-II) definition. Multivariable logistic regression was performed to construct the best-fit nomogram. The discrimination and calibration of the nomogram were evaluated by the area under the receiver operating characteristic curve (AUC-ROC) and calibration plot.Results: A total of 1200 patients were enrolled, of whom 66 (5.5%) developed sICH. In the multivariate logistic regression model, atrial fibrillation (odds ratio [OR] 3.25; 95% confidence interval [CI], 1.89− 5.60; P < 0.001), baseline glucose level (OR, 1.13; 95% CI, 1.07− 1.20; P < 0.001), neutrophil to lymphocyte ratio (OR, 1.05; 95% CI, 1.01− 1.09; P = 0.024) and baseline National Institute of Health Stroke Scale (NIHSS) (OR, 1.07; 95% CI, 1.04− 1.10; P < 0.001) were independent predictors for sICH and were used to generate the nomogram. The nomogram demonstrated good discrimination as the AUC-ROC value was 0.788 (95% CI, 0.737– 0.840). The calibration plot revealed good calibration.Conclusion: The nomogram consisted of atrial fibrillation, baseline glucose level, neutrophil to lymphocyte ratio, and NIHSS score may predict the risk of sICH in Chinese acute ischemic stroke patients treated with IVT.Keywords: stroke, intravenous thrombolysis, symptomatic intracranial hemorrhage, nomogram, predict

Keywords

• stroke
• intravenous thrombolysis
• symptomatic intracranial hemorrhage
• nomogram
• predict