Hypersensitive C-reactive protein-albumin ratio predicts symptomatic intracranial hemorrhage after endovascular therapy in acute ischemic stroke patients

Peng, Qiang; Hou, Jiankang; Wang, Siyu; Zhou, Feng; E, Yan; Wang, Wei; Huang, Ting; Wang, Meng; Huang, Shi; Zhou, Junshan; Chen, Nihong; Zhang, Yingdong

doi:10.1186/s12883-021-02066-2

Cited by 5 publications

(3 citation statements)

References 38 publications

(15 reference statements)

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“…Symptomatic HT is defined as any HT accompanied with an increase of at least 4 points in total National Institutes of Health Stroke Scale (NIHSS), an increase of at least 2 points in a single NIHSS category, or intubation, mortality, hemicraniectomy, or external ventricular drain placement. [ 15 16 ] Patients with symptomatic HT within the first 7 days after admission were considered as positive events.…”

Section: Methodsmentioning

confidence: 99%

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Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study

Islam,

Uygun,

Delipoyraz

et al. 2023

Turk J Emerg Med

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OBJECTIVES: Hemorrhagic transformation (HT) is significantly related to poor neurological outcomes and mortality. Although variables and models that predict HT have been reported in the literature, the need for a model with high diagnostic performance continues. We aimed to propose a model that can accurately predict symptomatic HT within 7 days of acute ischemic stroke (AIS). METHODS: Patients with AIS admitted to the emergency department of a tertiary training and research hospital between November 07, 2021, and August 26, 2022, were included in this single-center retrospective study. For the model, binary logistics with the forced-entry method was used and the model was validated with 3-fold cross-validation. After the final model was created, the optimal cutoff point was determined with Youden's index. Another cut-off point was determined at which the sensitivity was the highest. RESULTS: The mean age of the 423 patients included in the study was 70 (60–81) and 53.7% ( n = 227) of the patients were male. Symptomatic HT was present in 31 (7.3%) patients. Mechanical thrombectomy, atrial fibrillation, and diabetes mellitus were the independent predictors ( P < 0.001, P = 0.003, P = 0.006, respectively). The mean area under the curve of the receiver operating characteristics of the model was 0.916 (95% confidence interval [CI] = 0.876–0.957). The sensitivity for the optimal cut-off point was 90.3% (95% CI = 74.3%–97.9%) and specificity was 80.6% (95% CI = 76.4%–84.4%). For the second cutoff point where the sensitivity was 100%, the specificity was 60.5% (95% CI = 55.4%–65.3%). CONCLUSION: The diagnostic performance of our model was satisfactory and it seems to be promising for symptomatic HT. External validation studies are required to implement our results into clinical use.

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Section: Methodsmentioning

confidence: 99%

“…Patients whose condition worsened during follow-up and died before CT was performed were accepted as symptomatic HT, as in previous studies. [ 15 16 ]…”

Section: Methodsmentioning

confidence: 99%

Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study

Islam,

Uygun,

Delipoyraz

et al. 2023

Turk J Emerg Med

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“…SICH 26 Sung 27 TURN 28 Wang 29 ASIAN † 9 IER- ‡SICH † 10 Lee † 30 Peng † 31 Qian † 13 TAG* 11 Clinical characteristics Genot-PA 36 Kidwell 37 Krishnan 38 Puig 39 SPAN-100 40 Wu 41 Yeo 42 Zhou 43 Constant Dit Beau-fils|**| 44 Feng † 45 Liu † 46 Nael † 47 Yuan † 48 ASTRAL 49 DRAGON 50 iScore 51 Stroke-TPI 52 THRIVE †* 53 Total before a new model should be developed and externally validated. 12 Our study has several limitations.…”

Section: Ing-mentioning

confidence: 99%

Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models

Ende

Kremers

Steen

et al. 2023

Stroke

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Background: Symptomatic intracranial hemorrhage (sICH) is a severe complication of reperfusion therapy for ischemic stroke. Multiple models have been developed to predict sICH or intracranial hemorrhage (ICH) after reperfusion therapy. We provide an overview of published models and validate their ability to predict sICH in patients treated with endovascular treatment in daily clinical practice. Methods: We conducted a systematic search to identify models either developed or validated to predict sICH or ICH after reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) for ischemic stroke. Models were externally validated in the MR CLEAN Registry (n=3180; Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). The primary outcome was sICH according to the Heidelberg Bleeding Classification. Model performance was evaluated with discrimination (c-statistic, ideally 1; a c-statistic below 0.7 is considered poor in discrimination) and calibration (slope, ideally 1, and intercept, ideally 0). Results: We included 39 studies describing 40 models. The most frequently used predictors were baseline National Institutes of Health Stroke Scale (NIHSS; n=35), age (n=22), and glucose level (n=22). In the MR CLEAN Registry, sICH occurred in 188/3180 (5.9%) patients. Discrimination ranged from 0.51 (SPAN-100 [Stroke Prognostication Using Age and National Institutes of Health Stroke Scale]) to 0.61 (SITS-SICH [Safe Implementation of Treatments in Stroke Symptomatic Intracerebral Hemorrhage] and STARTING-SICH [STARTING Symptomatic Intracerebral Hemorrhage]). Best calibrated models were IST-3 (intercept, −0.15 [95% CI, −0.01 to −0.31]; slope, 0.80 [95% CI, 0.50−1.09]), SITS−SICH (intercept, 0.15 [95% CI, −0.01 to 0.30]; slope, 0.62 [95% CI, 0.38−0.87]), and STARTING−SICH (intercept, −0.03 [95% CI, −0.19 to 0.12]; slope, 0.56 [95% CI, 0.35−0.76]). Conclusions: The investigated models to predict sICH or ICH discriminate poorly between patients with a low and high risk of sICH after endovascular treatment in daily clinical practice and are, therefore, not clinically useful for this patient population.

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C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients

Liu

Qin

et al. 2023

CURR MED SCI

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Hypersensitive C-reactive protein-albumin ratio predicts symptomatic intracranial hemorrhage after endovascular therapy in acute ischemic stroke patients

Cited by 5 publications

References 38 publications

Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study

Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study

Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models

C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients

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