Clinical study on HAT and SEDAN score scales and related risk factors for predicting hemorrhagic transformation following thrombolysis in acute ischemic stroke

摘要

Objective To investigate the value of HAT and SEDAN score scales in predicting hemorrhagic transformation (HT) following the recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis in acute ischemic stroke patients and risk factors affecting HT. Methods A total of 143 patients with acute ischemic stroke underwent rt-PA intravenous thrombolysis within 4.50 h of onset and their clinical data were collected. According to head CT after thrombolysis, patients were divided into HT group (18 cases) and non-HT group (125 cases). Single factor analysis was used to assess differences in HAT and SEDAN score scales and related risk factors of ischemic stroke in 2 groups, and further Logistic regression analysis was used to investigate independent predictors of HT. Receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of HAT and SEDAN score scales in predicting HT. Results Univariate Logistic regression analysis showed that history of atrial fibrillation (AF), admission systolic blood pressure (SBP), admission blood glucose level, early low density of head CT, thrombolytic time window, National Institute of Health Stroke Scale (NIHSS), HAT and SEDAN scores were all risk factors for HT after thrombolysis (P < 0.05, for all). Multivariate Logistic regression analysis showed that history of AF (OR = 1.677, 95% CI: 1.332-2.111;?P = 0.000), admission SBP (OR = 1.102, 95% CI: 1.009-1.204;?P = 0.031), admission blood glucose level (OR = 1.870, 95% CI: 1.119-3.125;?P = 0.017),?thrombolysis time window (OR = 1.030, 95%CI: 1.009-1.052;?P = 0.005), NIHSS score (OR = 1.574, 95%CI: 1.186-2.090;?P = 0.002), HAT score (OR = 2.515, 95%CI: 1.273-4.970;P = 0.008) and SEDAN score (OR = 2.413, 95%CI: 1.123-5.185;?P = 0.024) were risk factors for HT after thrombolysis. ROC curve analysis showed that HAT score could predict HT with 94.40% sensitivity and 41.60% specificity, and area under curve (AUC) was 0.70. SEDAN score could predict HT with 94.40% sensitivity and 65.62% specificity, and AUC was 0.77. Conclusions History of AF, admission SBP, admission blood glucose level, thrombolysis time window, NIHSS, HAT and SEDAN score scales were independent risk factors for hemorrhagic transformation after intravenous thrombolysis for treating ischemic stroke, while SEDAN score had high predictive value.?DOI: 10.3969/j.issn.1672-6731.2015.02.008.