A predictive value of post-thrombolysis hemorrhagic transformation in acute cerebral infarction predicted by Alberta stroke program early CT score, hemorrhage after thrombolysis score and related factors / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the predictive value of Alberta stroke program early CT score (ASPECTS) and hemorrhage after thrombolysis score (HAT score) for the hemorrhagic transformation (HT) of acute cerebral infarction (ACI) patients after thrombolysis with Alteplase.Methods One hundred and twenty-one patients with ACI admitted to the Department of Neurology of Tianjin Jinghai District Hospital from January 2015to March 2017 were enrolled, they were all treated by using Alteplase 0.6 mg/kg for thrombolysis, maximum dose being 90 mg, and 1/10 of the total dose was intravenously injected in 1 minute, and then the residual part dissolved in 100 mL normal saline was intravenously dripped continuously for 1 hour. The ASPECTS and HAT score were carried out before the start of thrombolysis, and then the HT incidence situations in patients with different ASPECTSs and HAT scores were compared, and logistic regression analysis was used to analyze the risk factors of HT after thrombolysis in patients with ACI; then the receiver operating characteristic (ROC) curve was drawn, and the clinical value of HAT score and ASPECTS in diagnosing HT occurrence was analyzed.Results In cases with ACI, it was discovered that the higher the ASPECTS, the lower the incidence of HT, indicating that the incidences of HT in patients with ASPECTSs 0-4, 5-7, 8-10 were 57.1% (4/7), 26.7% (8/30), 14.3% (12/84) respectively; Similarly, in such cases, the higher the HAT scores, the higher the incidence of HT, showing that the incidences of HT of patients with HAT scores 0, 1, 2, ≥ 3 were 7.1% (4/56), 21.0% (8/38), 33.3% (7/21), 83.3% (5/6) respectively. The single factor analysis showed that the risk factors influencing the HT incidence included the systolic blood pressure on admission, anti-platelet medicine taken in the past history, the sign of high density of middle cerebral artery shown in head CT film on admission, the time of interval between the onset of the disease and the beginning of thrombolysis, HAT store and ASPECTS [odds ratio (OR) values were 0.972, 0.279, 0.992, 0.311, 2.628, 2.625, respectively, 95% confidence intervals (95%CI) were 0.9352-1.012, 0.093-0.836, 0.983-1.000, 0.105-0.916, 1.362-5.071, 1.522-4.525,P values were 0.034, 0.023, 0.042, 0.034, 0.003, 0.045 respectively]; the multifactorial logistic regression analysis showed that the independent risk factors influencing HT incidence were as follows the systolic blood pressure on admission, anti-platelet medicines taken in the past history, the sign of high density of the middle cerebral artery shown in the head CT film on admission, the time of interval between the onset of the disease and the beginning of thrombolysis, HAT score and ASPECTS (OR values were 1.766, 1.012, 1.574, 1.030, 2.155, 2.431, 95%CI were 1.233-2.103, 1.009-1.204, 1.186-2.091, 1.009-1.053, 1.237-4.907, 1.213-5.815,P values were 0.023, 0.004, 0.002, 0.005, 0.007, 0.047); HAT score and ASPECTS could predict the risk of HT incidence after venous thrombolytic therapy, sensitivity, specificity, area under ROC curve (AUC), 95%CI in ASPECTS were higher than thoes of HAT score (94.4% vs. 94.0%, 61.4 vs. 41.0%, 0.77 vs. 0.70, 0.710-0.830 vs. 0.650-0.800).Conclusions It is shown in this study that the higher the ASPECTS, the lower the incidence of HT, and the higher the HAT score, the higher the incidence of HT; both HAT score and ASPECTS can predict the risk of HT incidence after venous thrombolytic therapy, and the predictive value of ASPECTS system is higher than that of HAT score.