Patients A total of 243 patients with ischemic stroke were treated with IVT. Patients who underwent intra-arterial thrombolysis (n = 7) or endovascular thrombectomy (n = 29) and those who lacked complete data (n = 10) were excluded. As shown in Table 1, 24 (11%) of the baseline profile characteristics were post-thrombolytic HT. Table 2 Univariate logistic analysis showing NIHSS score, NLR, SBP, and NT-pro BNP (P < 0.05). After multivariate logistic analysis, NIHSS score, NLR, SBP, and NT-pro BNP were shown to be independent predictors of HT after intravenous thrombolysis in patients with ischemic stroke.
A nomogram of the HT predictive model was created based on these risk factors. The score for each independent predictor is the score corresponding to the upper scale, and the total score for each subject is the sum of the scores for each independent predictor. The total number of points corresponding to the HT risk axis is the risk of HT. The higher the total score, the higher the risk of HT. Internal validation of the Nomogram was performed by repeated sampling 1000 times using the Bootstrap method.
The model was created by combining the independent predictor values as described above and shown as a nomogram in Figure 1. The score for each predictor in the Nomo plot is determined by drawing a vertical line between the predictor fold and the preliminary score line. The total score is calculated by totaling the scores for each predictor, and the corresponding HT prediction probabilities are obtained by drawing a vertical line between the total score and the probability line. The area under the subject's work characteristics (ROC) curve for the prediction model was (Figure 2). In addition, the calibration curves of the nomograms for the likelihood of HT in patients showed good agreement (Figure 3), predicting the model HT probability. The calibration curves are shown in Figure 3. The calibration curves used to estimate HT showed no significant deviation from perfect match and good agreement between predicted and actual results. The analysis of the decision curve (DCA) (Figure 4) showed that clinical decision making based on the predictive model was beneficial and implied the practical clinical application and operability of the predictive model.
TABLE 1 | Baseline characteristics of AIS patients with IVT.
Variable
|
With HT(n=24)
|
Without HT(n=173)
|
Overall(n=197)
|
P-value
|
Demographics
|
Age,years
|
69.83±11.82
|
67.86±12.28
|
68.10±12.21
|
0.459
|
Male, n (%)
|
17 (70.8)
|
117 (67.6)
|
134 (68.0)
|
0.753
|
Medical history, n (%)
|
Hypertension
|
16 (66.7)
|
112 (64.7)
|
128 (65.0)
|
0.853
|
Diabetes mellitus
|
6 (25.0)
|
36 (20.8)
|
42 (21.3)
|
0.639
|
Coronary heart disease
|
5 (20.8)
|
30 (17.3)
|
35 (17.8)
|
0.675
|
smoking
|
7 (29.2)
|
43 (24.9)
|
50 (25.4)
|
0.649
|
drinking
|
6 (25.0)
|
30 (17.3)
|
36 (18.3)
|
0.363
|
Previous stroke
|
5 (20.8)
|
29 (16.8)
|
34 (17.3)
|
0.621
|
Clinical data
|
SBP, mmHg
|
164.88±22.94
|
151.35±19.51
|
152.99±20.38
|
0.002
|
DBP, mmHg
|
89.50 ±22.49
|
87.72 ±17.44
|
87.93±18.08
|
0.652
|
NIHSS, score
|
10.50 [7.00, 15.25]
|
6.00 [5.00, 8.00]
|
7.00 [5.00, 9.00]
|
<0.001
|
Time from onset to treatment, min
|
144.50 [112.50, 215.25]
|
171.00 [136.00, 211.00]
|
170.00 [125.00, 212.00]
|
0.651
|
Laboratory data
|
Glucose, mmol/L
|
7.70 ±2.24
|
7.17 ±2.27
|
7.23±2.26
|
0.286
|
NEUT, %
|
69.83±11.55
|
67.90±13.99
|
68.13±13.70
|
0.519
|
NLR
|
4.86 [3.40, 6.03]
|
3.07 [2.39, 3.64]
|
3.21 [2.45, 3.92]
|
<0.001
|
Platelet, 10∧9/L
|
172.50 [142.75, 211.25]
|
192.00 [160.00, 230.00]
|
191.00 [159.00, 229.00]
|
0.168
|
PT, s
|
13.78 [12.63, 15.12]
|
12.90 [10.89, 15.19]
|
13.12 [11.14, 15.19]
|
0.118
|
APTT, s
|
27.91 [24.41, 31.13]
|
29.04 [25.58, 31.81]
|
28.84 [25.50, 31.81]
|
0.384
|
INR
|
0.98 [0.90, 1.03]
|
0.98 [0.92, 1.04]
|
0.98 [0.92, 1.04]
|
0.574
|
TG, mmol/L
|
1.91±0.70
|
1.79 ±0.72
|
1.81 ±0.71
|
0.443
|
TC, mmol/L
|
3.38 [2.01, 4.94]
|
3.60 [2.52, 4.50]
|
3.60 [2.34, 4.51]
|
0.756
|
HDL, mmol/L
|
1.40 [0.97, 2.19]
|
1.77 [1.24, 2.24]
|
1.72 [1.20, 2.24]
|
0.383
|
LDL, mmol/L
|
3.09 [2.57, 3.79]
|
3.10 [2.42, 3.90]
|
3.10 [2.43, 3.89]
|
0.598
|
NT-pro BNP
|
302.67±127.53
|
205.39 ±100.24
|
217.25 ±108.37
|
<0.001
|
AIS, acute ischemic stroke; IVT, intravenous thrombolysis; HT, Hemorrhagic transformation; SBP, systolic blood pressure; DBP, diastolic blood pressure; NIHSS, National Institutes of Health Stroke Scale; NEUT, Neutrophilic granulocyte percentage; NLR, neutrophil-to-lymphocyte ratio; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, International normalized ratio; TG, triglyceride; TC, total cholesterol; HDL, High-density lipoprotein; LDL, low-density lipoprotein; NT-pro BNP, the N-terminal of the prohormone brain natriuretic peptide.
TABLE 2 | Univariable and multivariable analyses of HT in AIS patients with Intravenous thrombolysis.
Variable
|
Crude OR (95%CI)
|
Uni -P value
|
Adj OR (95%CI)
|
multi-P value
|
Age
|
1.014 [0.979, 1.052]
|
0.457
|
|
|
Male
|
1.162 [0.472, 3.152]
|
0.753
|
|
|
Hypertension
|
1.089 [0.452, 2.820]
|
0.853
|
|
|
Diabetes mellitus
|
1.269 [0.434, 3.276]
|
0.639
|
|
|
Coronary heart disease
|
1.254 [0.392, 3.409]
|
0.675
|
|
|
smoking
|
1.245 [0.456, 3.099]
|
0.65
|
|
|
drinking
|
1.589 [0.540, 4.153]
|
0.366
|
|
|
Previous stroke
|
1.307 [0.408, 3.560]
|
0.622
|
|
|
SBP
|
1.035 [1.012, 1.060]
|
0.003
|
1.039 [1.009, 1.075]
|
0.016
|
DBP
|
1.006 [0.982, 1.030]
|
0.65
|
|
|
NIHSS
|
1.335 [1.194, 1.519]
|
<0.001
|
1.362 [1.161, 1.652]
|
0.001
|
Time from onset to treatment
|
0.998 [0.991, 1.006]
|
0.674
|
|
|
GLU
|
1.099 [0.915, 1.301]
|
0.287
|
|
|
NEUT
|
1.011 [0.979, 1.044]
|
0.517
|
|
|
NLR
|
2.712 [1.889, 4.107]
|
<0.001
|
3.430 [2.082, 6.262]
|
<0.001
|
PLT
|
0.994 [0.986, 1.002]
|
0.146
|
|
|
PT
|
1.125 [0.980, 1.303]
|
0.104
|
|
|
APTT
|
0.961 [0.876, 1.050]
|
0.381
|
|
|
INR
|
0.204 [0.001, 29.445]
|
0.531
|
|
|
TG
|
1.266 [0.694, 2.318]
|
0.441
|
|
|
TC
|
0.949 [0.701, 1.279]
|
0.733
|
|
|
HDL
|
0.760 [0.405, 1.390]
|
0.379
|
|
|
LDL
|
1.143 [0.749, 1.763]
|
0.537
|
|
|
NT-pro BNP
|
1.008 [1.004, 1.013]
|
<0.001
|
1.012 [1.004, 1.020]
|
0.003
|
AIS, acute ischemic stroke; IVT, intravenous thrombolysis; HT, Hemorrhagic transformation; CI, confidence interval; OR, odds ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; NIHSS, National Institutes of Health Stroke Scale; NEUT, Neutrophilic granulocyte percentage; NLR, neutrophil-to-lymphocyte ratio; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, International normalized ratio; TG, triglyceride; TC, total cholesterol; HDL, High-density lipoprotein; LDL, low-density lipoprotein; NT-pro BNP, the N-terminal of the prohormone brain natriuretic peptide.