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Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies

2020; Elsevier BV; Volume: 29; Issue: 8 Linguagem: Inglês

10.1016/j.jstrokecerebrovasdis.2020.104940

1532-8511

João Brainer Clares de Andrade, J.P. Mohr, Fabrício Oliveira Lima, João José Freitas de Carvalho, Victor A. E. Farias, Jamary Oliveira‐Filho, Octávio Marques Pontes‐Neto, Rodrigo Bazán, Kristel Larisa Back Merida, Luisa Franciscato, Matheus Mendes Pires, Gabriel Pinheiro Módolo, Mayara Silva Marques, Renata Carolina Acri Nunes Miranda, Gisele Sampaio Silva,

Intracerebral and Subarachnoid Hemorrhage Research

Well studied in patients with ischemic stroke after reperfusion therapies (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).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 validation was assessed using datasets from 7 Comprehensive Stroke Centers using the area under the receiver operating characteristic curve (AUROC).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.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.