Risk prediction models for intracranial hemorrhage in acute ischemic stroke patients receiving intravenous alteplase treatment: a systematic review

Yaqi Hua; Chengkun Yan; Cheng Zhou; Qingyu Zheng; Dongying Li; Ping Tu

doi:10.3389/fneur.2023.1224658

Risk prediction models for intracranial hemorrhage in acute ischemic stroke patients receiving intravenous alteplase treatment: a systematic review

Front Neurol. 2024 Jan 5:14:1224658. doi: 10.3389/fneur.2023.1224658. eCollection 2023.

Authors

Yaqi Hua^{1

2}, Chengkun Yan², Cheng Zhou², Qingyu Zheng³, Dongying Li¹, Ping Tu³

Affiliations

¹ Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
² School of Nursing, Nanchang University, Nanchang, China.
³ Department of Post Anesthesia Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Abstract

Objectives: To identify and compare published models that use related factors to predict the risk of intracranial hemorrhage (ICH) in acute ischemic stroke patients receiving intravenous alteplase treatment.

Methods: Risk prediction models for ICH in acute ischemic stroke patients receiving intravenous alteplase treatment were collected from PubMed, Embase, Web of Science, and the Cochrane Library up to April 7, 2023. A meta-analysis was performed using Stata 13.0, and the included models were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results: A total of 656 references were screened, resulting in 13 studies being included. Among these, one was a prospective cohort study. Ten studies used internal validation; five studies used external validation, with two of them using both. The area under the receiver operating characteristic (ROC) curve for subjects reported in the models ranged from 0.68 to 0.985. Common predictors in the prediction models include National Institutes of Health Stroke Scale (NIHSS) (OR = 1.17, 95% CI 1.09-1.25, p < 0.0001), glucose (OR = 1.54, 95% CI 1.09-2.17, p < 0.05), and advanced age (OR = 1.50, 95% CI 1.15-1.94, p < 0.05), and the meta-analysis shows that these are independent risk factors. After PROBAST evaluation, all studies were assessed as having a high risk of bias but a low risk of applicability concerns.

Conclusion: This study systematically reviews available evidence on risk prediction models for ICH in acute ischemic stroke patients receiving intravenous alteplase treatment. Few models have been externally validated, while the majority demonstrate significant discriminative power.

Keywords: intracranial hemorrhage; ischemic stroke; models; systematic review; tissue plasminogen activator.

Publication types

Systematic Review

Grants and funding

This research was funded by the Jiangxi Province Education Department’s project (GJJ210183). No commercial entities were involved. The funding played no role in influencing the design and execution of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.