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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(05): 455-461
DOI: 10.1590/0004-282X-ANP-2021-0091
Article

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

Acurácia de escores preditivos de transformação hemorrágica em pacientes com isquemia cerebral aguda
João Brainer Clares de Andrade 
1   Columbia University, Department of Neurology, New York NY, USA.
2   Universidade Federal de São Paulo, São Paulo SP, Brazil.
,
Jay Preston Mohr 
1   Columbia University, Department of Neurology, New York NY, USA.
,
Muhammad Ahmad 
3   CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
,
Fabricio Oliveira Lima 
4   Hospital Geral de Fortaleza, Fortaleza CE, Brazil.
5   Universidade de Fortaleza, Fortaleza CE, Brazil.
,
Levi Coelho Maia Barros 
6   Universidade Estadual do Ceará, Fortaleza CE, Brazil.
,
Gisele Sampaio Silva 
2   Universidade Federal de São Paulo, São Paulo SP, Brazil.
7   Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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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.

RESUMO

Background: Transformação hemorrágica (TH) é uma complicação frequente no acidente vascular cerebral (AVC) isquêmico independente do uso de terapia de reperfusão (TR). Diversos escores preditivos de TH foram elaborados. Entretanto, a maioria desses escores incluíram pacientes submetidos a TR — o que pode levar à má interpretação do risco de TH nos pacientes não submetidos a TR. Objetivo: Nosso objetivo é revisar escores preditivos já publicados e analisar a sua acurácia em nossa amostra. Métodos: Analisamos a acurácia de sete escores. Nosso banco foi criado de uma coorte de 1.565 pacientes consecutivos, admitidos entre 2015 e 2017 em um centro avançado de AVC. Os pacientes realizaram neuroimagem de controle em até sete dias. Uma comparação entre áreas abaixo da curva/característica de operação do receptor (AUC) foi realizada, analisando-se as diferenças entre grupos de pacientes tratados ou não com ativador de plasminogênio tecidual recombinante (tPA). Resultados: Nosso banco de dados proporcionou informação suficiente para avaliar sete escores, dos quais seis foram aplicados em pacientes tratados ou não com tPA. HAT (AUC 0,76), HTI (0,73) e SEDAN (0,70) foram os escores mais acurados em pacientes não tratados com tPA. SPAN-100 (0,55) teve a pior acurácia nos grupos. Três desses escores apresentaram diferentes valores de corte entre os grupos. Conclusões: Os escores apresentaram de boa a moderada acurácia na predição de TH em pacientes tratados com tPA. Três escores foram mais acurados em pacientes não tratados com tPA. A parametrização dessas características e a inclusão de mais pacientes não tratados com TR em um estudo multicêntrico poderia levar a escores mais acurados.

Keywords:

Ischemic Stroke - Precision Medicine

Palavras-chave:

AVC Isquêmico - Medicina de Precisão

Authors’ contributions:

JBCA: planned the study, collected data and wrote the final version; JPM, FOL, JJFC, MZA: reviewed the report and wrote the final version; LCMB: collected data and wrote the final version; GSS: supervised the study, reviewed the report and wrote the final version.


Support

Dr. Andrade's visiting scholarship at Columbia University, New York City, is sponsored by the Capes Foundation, Ministry of Education, Brazil.




Publication History

Received: 04 March 2021

Accepted: 07 June 2021

Article published online:
06 February 2023

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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