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

Hongquan Guo; Wei Xu; Xiaohao Zhang; Shuai Zhang; Zheng Dai; Shun Li; Yi Xie; Yingle Li; Jianzhong Xue; Xinfeng Liu

doi:10.2147/NDT.S320574

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

Neuropsychiatr Dis Treat. 2021 Jul 6:17:2183-2190. doi: 10.2147/NDT.S320574. eCollection 2021.

Authors

Hongquan Guo^#¹, Wei Xu^#^{1

2}, Xiaohao Zhang^#³, Shuai Zhang⁴, Zheng Dai⁵, Shun Li⁶, Yi Xie³, Yingle Li¹, Jianzhong Xue⁷, Xinfeng Liu¹

Affiliations

¹ Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu, 210002, People's Republic of China.
² Department of Neurology, Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, 410000, People's Republic of China.
³ Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China.
⁴ Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225001, People's Republic of China.
⁵ Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China.
⁶ Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China.
⁷ Department of Neurology, Changshu No.2 People's Hospital, Changshu, Jiangsu, 215500, People's Republic of China.

^# Contributed equally.

Abstract

Background 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: intravenous thrombolysis; nomogram; predict; stroke; symptomatic intracranial hemorrhage.

Grants and funding

This study was supported in part by the National Natural Science Foundation of China (NO. U20A20357, 81870947), the National Key R&D project (NO. 2017YFC1307901) and Key R&D Program of Jiangsu Province (Clinical Frontier Technology Project) (NO. BE2020700).