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Journal of the Korean Neurological Association 2012;30(2): 100-109.
급성허혈뇌졸중에서 혈전용해치료의 유효성과 안전성에 관한 예후모형 개발
이지성, 이준영 강지훈 a 고영채 b 박종무 c 박태환 d 이경복 e 이수주 b 조용진 f 한문구 a 배희준 a
고려대학교 의과대학 의학통계학교실, 분당서울대학교병원 뇌졸중센터 신경과 a , 을지대학교 의과대학 을지대학병원 신경과 b , 을지대학교 의과대학 노원을지병원 신경과 c , 서울의료원 신경과 d , 순천향대학교 의과대학 신경과학교실 e , 인제대학교 의과대학 일산백병원 신경과 f
Prognostic Modeling for an Efficacy and a Safety of Thrombolysis in Acute Ischemic Stroke
Ji Sung Lee
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea Department of Neurology a , Stroke Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea Department of Neurology b , Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea Department of Neurology c , Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea Department of Neurology d , Seoul Medical Center, Seoul, Korea Department of Neurology e , Soonchunhyang University College of Medicine, Seoul, Korea Department of Neurology f , Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
Background: The aims of this study were to develop and internally and externally validate a prognostic model that can predict the benefit and harm of thrombolysis in patients with acute ischemic stroke and that may be used promptly in an emergency setting.
Methods: The data of a consecutive series of patients who were hospitalized to Seoul National University Bundang Hospital within 12?hours of stroke onset between January 2004 and March 2008 and with relevant ischemic lesions on diffusion-weighted MRI were used to develop and internally validate the prognostic model. The external validation was performed using the data of patients from five participating centers of the Clinical Research Center for Stroke that had been collected between April 2008 and September 2009. The score on the modified Rankin Disability Scale at 3 months was selected to determine the efficacy outcome, and the occurrence of symptomatic hemorrhagic transformation was used to evaluate the safety outcome. Prognostic models were constructed with logistic regression, and both internal and external validations were performed.
Results: The discriminative abilities of the efficacy model (C statistic=0.880) and the safety prognostic model (C statistic=0.864) were confirmed. External validation of both models revealed remarkably little degradation in the discrimination power (C statistic=0.835 and 0.822 for the efficacy and safety models, respectively).
Conclusions: This study shows that the efficacy and safety prognostic models developed with basic clinical variables were reliably validated with independent data. Both models may be helpful to clinicians in the emergency setting to identify patients who would benefit from thrombolysis. Key Words: Acute ischemic stroke, Outcome, Prognostic model, Thrombolysis