Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies
Main Author: | |
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Publication Date: | 2020 |
Other Authors: | , , , , , , , , , , , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Institucional da UNESP |
Download full: | http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104940 http://hdl.handle.net/11449/197895 |
Summary: | Background: Well studied in patients with ischemic stroke after reperfusion thera-pies (RT), hemorrhagic transformation (HT) is also common in patients not treated with RT and can lead to disability even in initially asymptomatic cases. The best predictors of HT in patients not treated with RT are not well established. Therefore, we aimed to identify predictors of HT in patients not submitted to RT and create a user-friendly predictive score (PROpHET). Material and Methods: Patients admitted to a Comprehensive Stroke Center from 2015 to 2017 were prospectively evaluated and randomly selected to the derivation cohort. A multivariable logistic regression modeling was built to produce a predictive grading score for HT. The external vali-dation was assessed using datasets from 7 Comprehensive Stroke Centers using the area under the receiver operating characteristic curve (AUROC). Results: In the derivation group, 448 patients were included in the final analysis. The validation group included 2,683 patients. The score derived from significant predictors of HT in the multivariate logistic regression analysis was male sex (1 point), ASPECTS <= 7 (2 points), presence of leukoaraiosis (1 point), hyperdense cerebral middle artery sign (1 point), glycemia at admission >= 180 mg/dL (1 point), cardioembolism (1 point) and lacunar syndrome (-3 points) as a protective factor. The grading score ranges from -3 to 7. A Score >= 3 had 78.2% sensitivity and 75% specificity, and AUROC of 0.82 for all cases of HT. In the validation cohort, our score had an AUROC of 0.83. Conclusions: The PROpHET is a simple, quick, cost-free, and easy-to-perform tool that allows risk stratification of HT in patients not submitted to RT. A cost-free computerized version of our score is available online with a user-friendly interface. |
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Predicting hemorrhagic transformation in patients not submitted to reperfusion therapiesIschemic strokeHemorrhagic transformationComplicationVascular neurologyBackground: Well studied in patients with ischemic stroke after reperfusion thera-pies (RT), hemorrhagic transformation (HT) is also common in patients not treated with RT and can lead to disability even in initially asymptomatic cases. The best predictors of HT in patients not treated with RT are not well established. Therefore, we aimed to identify predictors of HT in patients not submitted to RT and create a user-friendly predictive score (PROpHET). Material and Methods: Patients admitted to a Comprehensive Stroke Center from 2015 to 2017 were prospectively evaluated and randomly selected to the derivation cohort. A multivariable logistic regression modeling was built to produce a predictive grading score for HT. The external vali-dation was assessed using datasets from 7 Comprehensive Stroke Centers using the area under the receiver operating characteristic curve (AUROC). Results: In the derivation group, 448 patients were included in the final analysis. The validation group included 2,683 patients. The score derived from significant predictors of HT in the multivariate logistic regression analysis was male sex (1 point), ASPECTS <= 7 (2 points), presence of leukoaraiosis (1 point), hyperdense cerebral middle artery sign (1 point), glycemia at admission >= 180 mg/dL (1 point), cardioembolism (1 point) and lacunar syndrome (-3 points) as a protective factor. The grading score ranges from -3 to 7. A Score >= 3 had 78.2% sensitivity and 75% specificity, and AUROC of 0.82 for all cases of HT. In the validation cohort, our score had an AUROC of 0.83. Conclusions: The PROpHET is a simple, quick, cost-free, and easy-to-perform tool that allows risk stratification of HT in patients not submitted to RT. A cost-free computerized version of our score is available online with a user-friendly interface.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Fed Sao Paulo, Rua Napoleao Barros 715, Sao Paulo, SP, BrazilColumbia Univ, Doris & Stanley Tananbaum Stroke Ctr, Neurol Inst New York, 710 W 168th St,6TH Floor,NI 614, New York, NY 10032 USAUniv Fortaleza, Fortaleza, Cear, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilUniv Fed Ceara, Campus Quixada, Quixada, CE, BrazilUniv Fed Bahia, Salvador, BA, BrazilUniv Sao Paulo, Ribeirao Preto, BrazilUniv Estadual Paulista, Sao Paulo, BrazilHosp Inst Neurol Curitiba, Curitiba, Parana, BrazilHosp Geral Fortaleza, Rua Avila Goulart 900, Fortaleza, CE, BrazilPraca 15 Novembro SN, Salvador, BA, BrazilHosp Clin, Floor 4th, Ribeirao Preto, SP, BrazilAv Prof Mario Rubens Guimaraes Montenegro, Botucatu, SP, BrazilR Jeremias Maciel Perretto 300, Curitiba, PR, BrazilHosp Israelita Brasileiro Albert Einstein, Rua Albert Einstein 627, Sao Paulo, SP, BrazilUniv Estadual Paulista, Sao Paulo, BrazilElsevier B.V.Universidade Federal de São Paulo (UNIFESP)Columbia UnivUniv FortalezaHosp Geral FortalezaUniv Fed CearaUniversidade Federal da Bahia (UFBA)Universidade de São Paulo (USP)Universidade Estadual Paulista (Unesp)Hosp Inst Neurol CuritibaHosp Israelita Brasileiro Albert EinsteinAndrade, Joao Brainer Clares deMohr, Jay P.Lima, Fabricio OliveiraCarvalho, Joao Jose de FreitasFarias, Victor Aguiar Evangelista deOliveira-Filho, JamaryPontes-Neto, Octavio MarquesBazan, Rodrigo [UNESP]Merida, Kristel Larisa BackFranciscato, LuisaPires, Matheus MendesModolo, Gabriel Pinheiro [UNESP]Marques, Mayara SilvaMiranda, Renata Carolina Acri NunesSilva, Gisele Sampaio2020-12-12T00:07:54Z2020-12-12T00:07:54Z2020-08-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article10http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104940Journal Of Stroke & Cerebrovascular Diseases. Amsterdam: Elsevier, v. 29, n. 8, 10 p., 2020.1052-3057http://hdl.handle.net/11449/19789510.1016/j.jstrokecerebrovasdis.2020.104940WOS:000561808800067Web of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal Of Stroke & Cerebrovascular Diseasesinfo:eu-repo/semantics/openAccess2021-10-23T04:16:44Zoai:repositorio.unesp.br:11449/197895Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462021-10-23T04:16:44Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
title |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
spellingShingle |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies Andrade, Joao Brainer Clares de Ischemic stroke Hemorrhagic transformation ComplicationVascular neurology |
title_short |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
title_full |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
title_fullStr |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
title_full_unstemmed |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
title_sort |
Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies |
author |
Andrade, Joao Brainer Clares de |
author_facet |
Andrade, Joao Brainer Clares de Mohr, Jay P. Lima, Fabricio Oliveira Carvalho, Joao Jose de Freitas Farias, Victor Aguiar Evangelista de Oliveira-Filho, Jamary Pontes-Neto, Octavio Marques Bazan, Rodrigo [UNESP] Merida, Kristel Larisa Back Franciscato, Luisa Pires, Matheus Mendes Modolo, Gabriel Pinheiro [UNESP] Marques, Mayara Silva Miranda, Renata Carolina Acri Nunes Silva, Gisele Sampaio |
author_role |
author |
author2 |
Mohr, Jay P. Lima, Fabricio Oliveira Carvalho, Joao Jose de Freitas Farias, Victor Aguiar Evangelista de Oliveira-Filho, Jamary Pontes-Neto, Octavio Marques Bazan, Rodrigo [UNESP] Merida, Kristel Larisa Back Franciscato, Luisa Pires, Matheus Mendes Modolo, Gabriel Pinheiro [UNESP] Marques, Mayara Silva Miranda, Renata Carolina Acri Nunes Silva, Gisele Sampaio |
author2_role |
author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) Columbia Univ Univ Fortaleza Hosp Geral Fortaleza Univ Fed Ceara Universidade Federal da Bahia (UFBA) Universidade de São Paulo (USP) Universidade Estadual Paulista (Unesp) Hosp Inst Neurol Curitiba Hosp Israelita Brasileiro Albert Einstein |
dc.contributor.author.fl_str_mv |
Andrade, Joao Brainer Clares de Mohr, Jay P. Lima, Fabricio Oliveira Carvalho, Joao Jose de Freitas Farias, Victor Aguiar Evangelista de Oliveira-Filho, Jamary Pontes-Neto, Octavio Marques Bazan, Rodrigo [UNESP] Merida, Kristel Larisa Back Franciscato, Luisa Pires, Matheus Mendes Modolo, Gabriel Pinheiro [UNESP] Marques, Mayara Silva Miranda, Renata Carolina Acri Nunes Silva, Gisele Sampaio |
dc.subject.por.fl_str_mv |
Ischemic stroke Hemorrhagic transformation ComplicationVascular neurology |
topic |
Ischemic stroke Hemorrhagic transformation ComplicationVascular neurology |
description |
Background: Well studied in patients with ischemic stroke after reperfusion thera-pies (RT), hemorrhagic transformation (HT) is also common in patients not treated with RT and can lead to disability even in initially asymptomatic cases. The best predictors of HT in patients not treated with RT are not well established. Therefore, we aimed to identify predictors of HT in patients not submitted to RT and create a user-friendly predictive score (PROpHET). Material and Methods: Patients admitted to a Comprehensive Stroke Center from 2015 to 2017 were prospectively evaluated and randomly selected to the derivation cohort. A multivariable logistic regression modeling was built to produce a predictive grading score for HT. The external vali-dation was assessed using datasets from 7 Comprehensive Stroke Centers using the area under the receiver operating characteristic curve (AUROC). Results: In the derivation group, 448 patients were included in the final analysis. The validation group included 2,683 patients. The score derived from significant predictors of HT in the multivariate logistic regression analysis was male sex (1 point), ASPECTS <= 7 (2 points), presence of leukoaraiosis (1 point), hyperdense cerebral middle artery sign (1 point), glycemia at admission >= 180 mg/dL (1 point), cardioembolism (1 point) and lacunar syndrome (-3 points) as a protective factor. The grading score ranges from -3 to 7. A Score >= 3 had 78.2% sensitivity and 75% specificity, and AUROC of 0.82 for all cases of HT. In the validation cohort, our score had an AUROC of 0.83. Conclusions: The PROpHET is a simple, quick, cost-free, and easy-to-perform tool that allows risk stratification of HT in patients not submitted to RT. A cost-free computerized version of our score is available online with a user-friendly interface. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12-12T00:07:54Z 2020-12-12T00:07:54Z 2020-08-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104940 Journal Of Stroke & Cerebrovascular Diseases. Amsterdam: Elsevier, v. 29, n. 8, 10 p., 2020. 1052-3057 http://hdl.handle.net/11449/197895 10.1016/j.jstrokecerebrovasdis.2020.104940 WOS:000561808800067 |
url |
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104940 http://hdl.handle.net/11449/197895 |
identifier_str_mv |
Journal Of Stroke & Cerebrovascular Diseases. Amsterdam: Elsevier, v. 29, n. 8, 10 p., 2020. 1052-3057 10.1016/j.jstrokecerebrovasdis.2020.104940 WOS:000561808800067 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Journal Of Stroke & Cerebrovascular Diseases |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
10 |
dc.publisher.none.fl_str_mv |
Elsevier B.V. |
publisher.none.fl_str_mv |
Elsevier B.V. |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
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1799965542547718144 |