Validation assessment of risk scores to predict postthrombolysis intracerebral haemorrhage

<p><b>Background:</b> Two clinical risk scores, the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores, have been proposed to predict the risk of intracerebral haemorrhage following thrombolysis in acute ischaemic stroke.</p> <p><b>Aims:</b> To validate Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores as predictors of post-tissue plasminogen activator symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage in an independent cohort.</p> <p><b>Methods:</b> Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were calculated for the cohort of tissue plasminogen activator-treated patients enrolled in the placebo arms of the SAINT-I and SAINT-II trials. The absolute risk of symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage associated with each scoring system was determined. The overall predictive value was assessed using c-statistics.</p> <p><b>Results:</b> Symptomatic intracerebral haemorrhage occurred in 5 center dot 6% of 965 patients treated with tissue plasminogen activator in the SAINT cohorts. The risk of symptomatic intracerebral haemorrhage was modestly greater, with higher Haemorrhage After Thrombolysis scores (0: 4 center dot 1%, 1: 4 center dot 1%, 2: 8 center dot 8%, 3: 12 center dot 5%, 4: 0%, 5: no subjects). Similar results were seen with the Multicentre Stroke Survey score (0: 0%, 1: 4 center dot 8%, 2: 2 center dot 3%, 3: 7 center dot 3%, 4: 6 center dot 3%). In logistic regression, the Haemorrhage After Thrombolysis score was associated with the risk of symptomatic intracerebral haemorrhage (odds ratio=1 center dot 41 per point, 95% confidence interval: 1 center dot 05-1 center dot 89, P=0 center dot 021) and asymptomatic intracerebral haemorrhage (odds ratio=1 center dot 59 per point, 95% confidence interval: 1 center dot 33-1 center dot 92, P &lt; 0 center dot 001). The Multicentre Stroke Survey score was modestly associated with the risk of symptomatic intracerebral haemorrhage (odds ratio=1 center dot 43 per point, 95% confidence interval: 0 center dot 95-2 center dot 15, P=0 center dot 084) and asymptomatic intracerebral haemorrhage (odds ratio=1 center dot 63 per point, 95% confidence interval: 1 center dot 27-2 center dot 08, P &lt; 0 center dot 001). The c-statistic was 0 center dot 59 for predicting symptomatic intracerebral haemorrhage and 0 center dot 61 for asymptomatic intracerebral haemorrhage for both the Haemorrhage After Thrombolysis and the Multicentre Stroke Survey scores.</p> <p><b>Conclusions:</b> While both the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were associated with a risk of symptomatic intracerebral haemorrhage, discriminatory ability was limited.