External validation of different predictive scoring systems for intracranial hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke

LIN Ya-nan; HAN Jie

doi:10.3969/j.issn.1672-6731.2025.08.011

Abstract：Objective To externally validate different predictive scoring systems for intracranial hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke,and to evaluate the predictive abilities of the different scoring systems.Methods A total of 1157 patients with acute ischemic stroke who received rt-PA intravenous thrombolysis within 4.50 h after symptom onset were collected from July 2010 to August 2023 in The First Affiliated Hospital of Dalian Medical University.According to the imaging examination within 36 h after intravenous thrombolysis,98 cases presented with intracranial HT and 34 cases presented with symptomatic intracranial hemorrhage(sICH).The area under the curve(AUC)of receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess the discrimination and calibration of the HAT score,the MSS score,the SEDAN score,the GRASPS score and the SPAN-100 score for the prediction of HT and sICH,respectively.Results The incidence of intracranial HT and sICH were 8.47%(98/1157)and 2.94%(34/1157),respectively.The AUCs of the scoring systems for predicting intracranial HT were 0.625(95%CI:0.563-0.687)for the HAT score,0.663(95%CI:0.609-0.718)for the MSS score,0.641(95%CI:0.581-0.702)for the SEDAN score,and 0.701(95%CI:0.644-0.759)for the GRASPS score.In predicting sICH,the AUCs of the scoring systems were 0.695(95%CI:0.595-0.795)for the HAT score,0.691(95%CI:0.609-0.773)for the MSS score,0.689(95%CI:0.590-0.788)for the SEDAN score,and 0.783(95%CI:0.714-0.852)for the GRASPS score.In addition,the Hosmer-Lemeshow goodness-of-fit tests of the HAT score,the MSS score,the SEDAN score and the GRASPS score were P>0.05 for both validation of intracranial HT and sICH,suggesting that all scoring systems were well calibrated.The sensitivities of the SPAN-100 score for predicting intracranial HT and sICH were 14.30%and 23.50%,respectively,suggesting that the SPAN-100 score has a high risk of underdiagnosis in clinical practice.Conclusions The GRASPS score has a fair predictive ability for predicting intracranial HT and sICH after intravenous thrombolysis in acute ischemic stroke patients.Further external validations with large samples in multiple centers will be needed in different populations.