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Predicting risk of symptomatic intracerebral hemorrhage and mortality after treatment with recombinant tissue‐plasminogen activator using SEDAN score
Author(s) -
AlKhaled M.,
Langner B.,
Brüning T.
Publication year - 2016
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12447
Subject(s) - medicine , intracerebral hemorrhage , thrombolysis , logistic regression , tissue plasminogen activator , stroke (engine) , complication , recombinant tissue plasminogen activator , receiver operating characteristic , gastroenterology , surgery , ischemic stroke , subarachnoid hemorrhage , ischemia , myocardial infarction , modified rankin scale , mechanical engineering , engineering
Background and purpose The most feared complication after treatment with recombinant tissue‐plasminogen activator (rt‐ PA ) is the occurrence of symptomatic intracerebral hemorrhage ( sICH ). The aims of the study were to predict the risk of sICH ( ECASS II definition) after a therapy with rt‐ PA and to examine whether associations exist between SEDAN score and the early mortality in patients with acute ischemic stroke in a monocenter study. Methods During a 6‐year period (2008–2013), 542 consecutive stroke patients (mean age, 73 ± 3 years; 51.1% women; median NIHSS score, 11) treated with IV thrombolysis were included in a monocenter study. SICH was diagnosed in according to the with ECASS II definition. Results The absolute risk for sICH revealed 9.2% (95% CI , 6.5–11.4) of patients treated with IV thrombolysis and was 0%, 4.6% (95% CI , 1.3–7.9), 6.6% (95% CI , 3.3–10.5), 13.5% (95% CI , 6.7–19.2), 23.6% (95% CI , 12.7–34.5), and 26.7% (95% CI , 12.7–34.5) for 0, 1, 2, 3, 4, and ≥5 SEDAN points. Logistic regression revealed that sICH was associated with increasing SEDAN scores ( OR , 1.93 per SEDAN point; 95% CI , 1.51–2.46; P < 0.001). The predictive performance was assessed with area under a receiver operating characteristic curve (0.73; 95% CI , 0.65–0.80; P < 0.001). During hospitalization (median, 9 days), 53 patients (9.8%; 95% CI , 7.4–12.45) died. In‐hospital mortality was higher in patients with than those without sICH (30 vs 7.7%; P < 0.001), and it was increased with increasing SEDAN score ( OR , 1.45 per point; 95% CI , 1.12–1.89; P = 0.005). Conclusions Higher SEDAN score was associated with an increased risk of sICH and early mortality in this monocenter study.