Risk score for predicting upper gastrointestinal bleeding after intravenous thrombolysis in elderly patients with acute cerebral infarction / 中华老年医学杂志

ABSTRACT

Objective:The purpose of this study was to develop a risk score for predicting upper gastrointestinal hemorrhage(UGIH)in acute ischemic stroke(AIS)patients following intravenous thrombolysis.Methods:A retrospective analysis of 203 elderly AIS patients treated with intravenous thrombolysis was conducted in this study.Patients were divided into an UGIH group and a non-NUGIH group, with 40 in the former group and 163 in the latter group.Baseline data at admission were collected to predict UGIH after intravenous thrombolysis.Logistic regression analysis was used to examine independent risk factors affecting UGIH.The score was developed according to regression coefficients.The area under the receiver operating characteristic curve(AUROC)was used to evaluate the sensitivity and specificity of the risk score.The maximum value of the Youden index was used to determine the cutoff value for predicting UGIH.Results:Univariate analysis showed smoking( χ2=4.825, P=0.037), age( χ2=16.927, P<0.001), atrial fibrillation( χ2=14.176, P<0.001), NIHSS score( χ2=29.075, P<0.001), nasogastric intubation( χ2=47.339, P<0.001)and antiplatelet therapy( χ2=56.585, P<0.001)were associated with UGIH.Multivariate analysis found that NIHSS score( OR=2.902, 95% CI 1.053-8.003)and nasogastric intubation( OR=6.300, 95% CI 2.281-17.404)were independent risk factors affecting UGIH.The scoring system was named N2, and the total score was 3 points.The N2 scoring system had a good predictive ability(AUROC 0.828, 95% CI 0.758-0.899). The cut-off value was 2, the sensitivity was 0.775, and the specificity was 0.791.AIS patients with an N2 score ≥2 were at risk of UGIH after intravenous thrombolysis. Conclusions:The N2 score may be a valid predictive model for AIS patients at high-risk for UGIH after intravenous thrombolysis.Patients with an N2 score≥2 need preventive measures against UGIH.