Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study
OBJECTIVES: Hemorrhagic transformation (HT) is significantly related to poor neurological outcomes and mortality. Although variables and models that predict HT have been reported in the literature, the need for a model with high diagnostic performance continues. We aimed to propose a model that can...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-07-01
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| Series: | Turkish Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/tjem.tjem_33_23 |
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| _version_ | 1823863952023486464 |
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| author | Mehmet Muzaffer Islam Cemrenur Uygun Melike Delipoyraz Merve Osoydan Satici Servan Kurt Enis Ademoglu Serkan Emre Eroglu |
| author_facet | Mehmet Muzaffer Islam Cemrenur Uygun Melike Delipoyraz Merve Osoydan Satici Servan Kurt Enis Ademoglu Serkan Emre Eroglu |
| author_sort | Mehmet Muzaffer Islam |
| collection | DOAJ |
| description | OBJECTIVES:
Hemorrhagic transformation (HT) is significantly related to poor neurological outcomes and mortality. Although variables and models that predict HT have been reported in the literature, the need for a model with high diagnostic performance continues. We aimed to propose a model that can accurately predict symptomatic HT within 7 days of acute ischemic stroke (AIS).
METHODS:
Patients with AIS admitted to the emergency department of a tertiary training and research hospital between November 07, 2021, and August 26, 2022, were included in this single-center retrospective study. For the model, binary logistics with the forced-entry method was used and the model was validated with 3-fold cross-validation. After the final model was created, the optimal cutoff point was determined with Youden’s index. Another cut-off point was determined at which the sensitivity was the highest.
RESULTS:
The mean age of the 423 patients included in the study was 70 (60–81) and 53.7% (n = 227) of the patients were male. Symptomatic HT was present in 31 (7.3%) patients. Mechanical thrombectomy, atrial fibrillation, and diabetes mellitus were the independent predictors (P < 0.001, P = 0.003, P = 0.006, respectively). The mean area under the curve of the receiver operating characteristics of the model was 0.916 (95% confidence interval [CI] = 0.876–0.957). The sensitivity for the optimal cut-off point was 90.3% (95% CI = 74.3%–97.9%) and specificity was 80.6% (95% CI = 76.4%–84.4%). For the second cutoff point where the sensitivity was 100%, the specificity was 60.5% (95% CI = 55.4%–65.3%).
CONCLUSION:
The diagnostic performance of our model was satisfactory and it seems to be promising for symptomatic HT. External validation studies are required to implement our results into clinical use. |
| format | Article |
| id | doaj-art-d2385b7fc9a242f69e0f5234c741cbc4 |
| institution | Kabale University |
| issn | 2452-2473 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Turkish Journal of Emergency Medicine |
| spelling | doaj-art-d2385b7fc9a242f69e0f5234c741cbc42025-02-09T08:57:26ZengWolters Kluwer Medknow PublicationsTurkish Journal of Emergency Medicine2452-24732023-07-0123317618310.4103/tjem.tjem_33_23Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort studyMehmet Muzaffer IslamCemrenur UygunMelike DelipoyrazMerve Osoydan SaticiServan KurtEnis AdemogluSerkan Emre ErogluOBJECTIVES: Hemorrhagic transformation (HT) is significantly related to poor neurological outcomes and mortality. Although variables and models that predict HT have been reported in the literature, the need for a model with high diagnostic performance continues. We aimed to propose a model that can accurately predict symptomatic HT within 7 days of acute ischemic stroke (AIS). METHODS: Patients with AIS admitted to the emergency department of a tertiary training and research hospital between November 07, 2021, and August 26, 2022, were included in this single-center retrospective study. For the model, binary logistics with the forced-entry method was used and the model was validated with 3-fold cross-validation. After the final model was created, the optimal cutoff point was determined with Youden’s index. Another cut-off point was determined at which the sensitivity was the highest. RESULTS: The mean age of the 423 patients included in the study was 70 (60–81) and 53.7% (n = 227) of the patients were male. Symptomatic HT was present in 31 (7.3%) patients. Mechanical thrombectomy, atrial fibrillation, and diabetes mellitus were the independent predictors (P < 0.001, P = 0.003, P = 0.006, respectively). The mean area under the curve of the receiver operating characteristics of the model was 0.916 (95% confidence interval [CI] = 0.876–0.957). The sensitivity for the optimal cut-off point was 90.3% (95% CI = 74.3%–97.9%) and specificity was 80.6% (95% CI = 76.4%–84.4%). For the second cutoff point where the sensitivity was 100%, the specificity was 60.5% (95% CI = 55.4%–65.3%). CONCLUSION: The diagnostic performance of our model was satisfactory and it seems to be promising for symptomatic HT. External validation studies are required to implement our results into clinical use.https://journals.lww.com/10.4103/tjem.tjem_33_23hemorrhagestrokethrombectomythrombolysis |
| spellingShingle | Mehmet Muzaffer Islam Cemrenur Uygun Melike Delipoyraz Merve Osoydan Satici Servan Kurt Enis Ademoglu Serkan Emre Eroglu Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study Turkish Journal of Emergency Medicine hemorrhage stroke thrombectomy thrombolysis |
| title | Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study |
| title_full | Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study |
| title_fullStr | Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study |
| title_full_unstemmed | Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study |
| title_short | Predictors of 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study |
| title_sort | predictors of 7 day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool a retrospective cohort study |
| topic | hemorrhage stroke thrombectomy thrombolysis |
| url | https://journals.lww.com/10.4103/tjem.tjem_33_23 |
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