Prediction of Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke, Phetchabun Hospital

Abstract

This study aimed to develop a clinical prediction score for forecasting intracerebral hemorrhage (ICH) following intravenous thrombolysis (rt-PA) in patients with acute ischemic stroke at Phetchabun Hospital. A retrospective cohort study was conducted among patients with acute ischemic stroke who received rt-PA treatment at the stroke unit of Phetchabun Hospital between January 1, 2018, and June 30, 2024. Post-treatment complications were classified into three groups: 1) no complications, 2) asymptomatic intracerebral hemorrhage, and 3) symptomatic intracerebral hemorrhage with worsening neurological deficits. Data analysis was performed using ordinal logistic regression to identify factors associated with the occurrence of ICH, and the Area Under the Receiver Operating Characteristic Curve (AuROC) was used to assess the predictive accuracy of the model. The study included 317 patients, classified into three groups: 1) no complications (260 patients, 82.0%), 2) asymptomatic ICH (15 patients, 4.8%), and 3) symptomatic ICH with neurological deterioration (42 patients, 13.2%). The Symptomatic Intracerebral Hemorrhage (sICH) score was derived from six variables associated with ICH: age over 60 years, blood glucose levels higher than 200 mg/dL, history of aspirin use, NIHSS score greater than 20, platelet count lower than 250,000 cells/mm³, and the use of antihypertensive medication during rt-PA administration. The score ranged from 0 to 7.5, with a cut-off point at 2.5. The AuROC for the prediction score was 0.74 (95%CI: 0.70-0.80). Future studies should include a more diverse patient population with varying clinical characteristics, as well as employ longitudinal study designs to improve the predictive accuracy of the score and facilitate its broader clinical application.