Derivation and Validation of a Scoring System for Intravenous Tissue Plasminogen Activator Use in Asian Patients

Leonard L L Yeo; Shih-Chao Chien; Jr-Rung Lin; Chia-Wei Liow; Jiann-Der Lee; Tsung-I Peng; Teoh Hock Luen; Vijay Sharma; Bernard Chan; Tsong-Hai Lee; SRICHS Group

doi:10.1016/j.jstrokecerebrovasdis.2017.03.033

Derivation and Validation of a Scoring System for Intravenous Tissue Plasminogen Activator Use in Asian Patients

J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1695-1703. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.033. Epub 2017 Apr 10.

Authors

Affiliations

¹ Division of Neurology, Department of Medicine, National University Health System, Singapore.
² Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
³ Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
⁴ Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁵ Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁶ Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
⁷ Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: thlee@adm.cgmh.org.tw.

PMID: 28408066
DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.033

Abstract

Background and purpose: As Chinese Asian populations have an increased risk of intracerebral hemorrhage (ICH) after intravenous tissue plasminogen activator (IV tPA), we aimed to design a rapid, clinically applicable risk scoring system to predict ICH and functional outcomes after IV tPA treatment in Asian ischemic stroke patients.

Methods: From January 2009 to December 2012, consecutive acute ischemic stroke patients treated with IV tPA recruited from the Stroke Registry in Chang Gung Healthcare System (SRICHS) in Taiwan and the National University Hospital of Singapore (NUHS) acute stroke database were used to create and validate a scoring system. Nomogram was created for ICH and 3-month mortality.

Results: In total, 932 patients were included in the study: 386 from SRICHS for the derivation of scoring system and 546 from NUHS to validate it. We used nomograms to assign weightage to the scoring system. The presence of atrial fibrillation, glucose level, and the National Institutes of Health Stroke Scale (NIHSS) score were significantly associated with the risk of ICH. Age, NIHSS score, hyperlipidemia, and the presence of post-tPA ICH were significantly associated with mortality. The areas under the curve of derivation and validation cohorts were .663 and .662 for ICH, and .808 and .790 for mortality, respectively.

Conclusions: The scoring system using nomograms can provide a fast, practical, and user-friendly tool that allows physicians to predict the risk of ICH and functional outcomes with IV tPA treatment in a clinical setting.

Keywords: critical care; intracerebral hemorrhage; nomograms; prognosis; stroke; tissue plasminogen activator.

Publication types

Multicenter Study
Validation Study

MeSH terms

Administration, Intravenous
Aged
Aged, 80 and over
Asian People*
Cerebral Hemorrhage / chemically induced
Clinical Decision-Making
Databases, Factual
Decision Support Techniques*
Female
Fibrinolytic Agents / administration & dosage*
Fibrinolytic Agents / adverse effects
Humans
Male
Middle Aged
Nomograms
Patient Selection
Predictive Value of Tests
Registries
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Singapore / epidemiology
Stroke / diagnosis
Stroke / drug therapy*
Stroke / ethnology
Stroke / mortality
Taiwan / epidemiology
Thrombolytic Therapy / adverse effects
Thrombolytic Therapy / methods*
Thrombolytic Therapy / mortality
Tissue Plasminogen Activator / administration & dosage*
Tissue Plasminogen Activator / adverse effects
Treatment Outcome

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator