Accuracy of predictive scores of hemorrhagic transformation in patients with acute ischemic stroke

Abstract

Background: Hemorrhagic transformation (HT) is a complication in ischemic strokes, regardless of use of reperfusion therapy (RT). There are many predictive scores for estimating the risk of HT. However, most of them include patients also treated with RT. Therefore, this may lead to a misinterpretation of the risk of HT in patients who did not undergo RT. Objective: We aimed to review published predictive scores and analyze their accuracy in our dataset. Methods: We analyzed the accuracy of seven scales. Our dataset was derived from a cohort of 1,565 consecutive patients from 2015 to 2017 who were admitted to a comprehensive stroke center. All patients were evaluated with follow-up neuroimaging within seven days. Comparison of area under the curve (AUC) was performed on each scale, to analyze differences between patients treated with recombinant tissue plasminogen activator (tPA) and those without this treatment. Results: Our dataset provided enough data to assess seven scales, among which six were used among patients with and without tPA treatment. HAT (AUC 0.76), HTI (0.73) and SEDAN (0.70) were the most accurate scores for patients not treated with tPA. SPAN-100 (0.55) had the worst accuracy in both groups. Three of these scores had different cutoffs between study groups. Conclusions: The predictive scores had moderate to fair accuracy for predicting HT in patients treated with tPA. Three scales were more accurate for predicting HT in patients not treated with tPA. Through standardizing these characteristics and including more patients not treated with RT in a large multicenter series, accurate predictive scores may be created.

Heterogeneous treatment effects of Cerebrolysin as an early add-on to reperfusion therapy: post hoc analysis of the CEREHETIS trial

“…The HTI score (ASPECTS: 10-7 = 0, 6-5 = 1, 4-3 = 2, 2-0 = 3; NIHSS: 0-11 = 0, 12-17 = 1, 18-23 = 2, >23 = 3; HMCA sign: yes = 1; atrial fibrillation on ECG: yes = 1; score range 0-8) has been developed and externally validated to predict any HT in MCA stroke patients regardless of IVT (Kalinin et al, 2017;Andrade et al, 2022).…”

Serum biomarkers to predict hemorrhagic transformation and ischemic stroke outcomes in a prospective cohort study

“…This can be attributed to the complex and diverse underlying pathological mechanisms contributing to ischemic stroke. Numerous laboratory parameters have been analyzed in both fundamental and clinical studies, including admission glycemia [10], serum lipids profile [11], as well as markers of inflammatory response such as C-reactive protein (CRP), leukocyte count, and neutrophil-to-lymphocyte ratio [12]. Additionally, specific proteins associated with neuronal injury (e.g., neuron-specific enolase, S100B) and blood-brain barrier disruption (e.g., tight junction proteins, matrix metalloproteinases, cellular fibronectin) have been investigated, with variable sensibility and specificity, indicating the necessity of further research in the field [13][14][15][16].…”