Predictive value of National Institute of Health Stroke Scale and Glasgow Coma Scale scores for bleeding after thrombolytic therapy in patients with acute cerebral infarction / 中华老年医学杂志

ABSTRACT

Objective:To evaluate the predictive value of the National Institutes of Health Stroke Scale(NIHSS)score and the Glasgow Coma Scale(GCS)score for bleeding in patients with acute cerebral infarction after thrombolytic therapy.Methods:A total of 281 patients with acute cerebral infarction were enrolled at Henan Provincial People's Hospital and were treated with urokinase or recombinant human tissue plasminogen activator(rt-PA)for thrombolysis.The patients were followed up for up to 1 month after thrombolysis.Data on age, sex, time to thrombolysis, smoking, systolic blood pressure, platelets, prothrombin time, international normalized ratio, and NIHSS and GCS scores were collected.Logistic regression analysis was used to identify related factors for bleeding after thrombolysis in acute cerebral infarction and the receiver-operating characteristic curve(ROC)was used to assess the predictive values of these factors through calculating the area under the curve(AUC).Results:Logistic regression analysis showed that time to thrombolysis, prothrombin time before thrombolysis, NIHSS score before thrombolysis, NIHSS score 24 h after thrombolysis, GCS score before thrombolysis, and GCS score 24 h after thrombolysis were independent factors for hemorrhage after thrombolytic therapy( OR=23.318, 0.238, 17.099, 4.561, 0.004, and 0.258, P=0.038, 0.021, 0.038, 0.027, 0.006, and 0.040, respectively).ROC curve analysis showed that NIHSS score before thrombolysis, NIHSS score 24 h after thrombolysis, and time to thrombolysis were important factors for predicting bleeding after thrombolysis(AUC=0.833, 0.795, and 0.714, respectively, all P=0.000). Conclusions:For patients with acute cerebral infarction, the risk of bleeding after thrombolysis is significantly increased if the NIHSS score is unfavorable before thrombolysis or 24 h after thrombolysis, or the duration of acute cerebral infarction is long.Attention to risk factors and early intervention are warranted.