Simple prediction model for unfavorable outcome in ischemic stroke after intravenous thrombolytic therapy

Amitrano, Daniel A.; Silva, Ivan Rocha Ferreira da; Liberato, Bernardo; Batistella, Valéria; Oliveira, Janaina; Nascimento, Osvaldo J. M.

doi:10.1590/0004-282x20160152

Cited by 11 publications

(18 citation statements)

References 15 publications

(13 reference statements)

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“…In a study that that included 82 patients with acute ischemic stroke treated with thrombolytic therapy, found that NIHSS score > 12 on arrival, age > 70 years and the presence of hyperdense artery sign (according to ASPE CT assessment) are predictors of unfavourable outcome Fig. 1 Evolution of NIHSS from admission to the evaluation at 7 days at 3 months [27]. According to our findings, we observed that increased initial ASPECTS score was associated with better outcomes.…”

Section: Discussionsupporting

confidence: 62%

Additional factors to corelate with a more than 30% NIHSS score improvement in patients 7 days after fibrinolytic and/or endovascular treatment for ischemic stroke

et al. 2020

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Background Our objective was to find which additional factors can influence the favorable result in stroke patients after receiving fibrinolytic and/or endovascular treatment, quantified as a more than 30% improvement of the NIHSS score at 7 days. Methods This is a retrospective study to find factors that could influence a favorable evolution of patients with stroke that underwent fibrinolytic and or thrombectomy using the NIHSS score changes. At the admission in the hospital, blood glucose, blood count, coagulation time, INR, aPTT, PT, platelet count, NIHSS questionnaire and ASPECTS score were collected. NIHSS was assessed at the admission, after 1 h, after 2 h, after 24 h and after 7 days. Results As compared to the initial evaluation, at 7 days after admission 59% (72) of patients have improved with more than 30% the NIHSS. Higher levels of systolic blood pressure, glycemia and lower ASPECTS score at admission were observed in non-achievers. The value of INR contributed to model: for every unit increase of INR, the chance of better outcome decreases by 90,1%. High glycemia has also a negative impact: for every unit increase, the chance of better outcome decreases by 24%. Higher initial ASPECTS score is associated with better outcomes: each point increase of ASPECTS score at initial evaluation, increases the chance of better outcome by 154.2%. Conclusion Males, older age, diabetes, and hyperglycemia correlate with a worse outcome after cerebral stroke regardless of the benefit yielded fibrinolytic and/or thrombectomy therapy. In this study, patients with the above-mentioned factors did not improve more than 30% of baseline NIHSS score from admission to the 7th day.

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Section: Discussionsupporting

confidence: 62%

Additional factors to corelate with a more than 30% NIHSS score improvement in patients 7 days after fibrinolytic and/or endovascular treatment for ischemic stroke

et al. 2020

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“…We found that patients with hyperdense middle cerebral artery (HMCA) and those with a large-sized infarction had unfavorable outcomes; however, the association did not reach significance. HMCA sign has been recorded as a factor of a high incidence of unfavorable outcome [33] and used as an item of thrombotic stroke instrument designed to predict poor outcomes [34]. A recent meta-analysis [35] found that patients with an initial HMCAS were 1.56-fold more likely to have unfavorable outcomes than those who did not present with this sign.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcome in ischemic stroke patients after thrombolytic therapy

Mohamed

Ghaffar

Gawad

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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Background Stroke represents the second leading cause of death in the world after myocardial infarction. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (alteplase, rt-PA) is the only pharmacological therapy that was approved for treatment within 4.5 h of acute ischemic stroke (AIS) onset. We aimed to predict the 3-month outcome of AIS patients who received alteplase regarding mortality, spontaneous intra-cerebral hemorrhage (sICH), and functional outcome in comparison with non-thrombolyzed patients and to evaluate the predictors of the outcome after 3 months. Methods All the clinical, National Institute of Health Stroke Scale (NIHSS) scores, radiological, and laboratory data of 40 AIS patients and received rt-PA during the period from 2016 to 2018 were collected and analyzed retrospectively. For comparison, 40 patients, as a control group, were selected to match the alteplase group as regards the baseline data and received regular treatment, rather than rt-PA within the first 24 h, that were obtained. The outcome of the thrombolyzed patients after 3 months was evaluated in comparison with controls by using a modified ranking scale. Results After a 90-day follow-up period, the death rate was slightly higher among the rt-PA group (7.5%) in comparison with the control group (5%). sICH occurred in 7.5% of the patients in the alteplase group and in 5% of the non-thrombolyzed patients; however, this difference was not significant. More patients had a favorable outcome (mRS = 0–2) in the rt-PA group than in the control group (65% vs 60%, OR 1.38, 95% CI 0.50–3.6, P = 0.51). NIHSS score on admission, body mass index (BMI) (≥ 30), and previous transient ischemic attacks (TIA)/previous ischemic stroke were significant predictors of outcome after IV thrombolysis. Age, sex, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, smoking, atrial fibrillation (AF), stroke subtype, size of infarction, and hyperdense middle cerebral artery had a non-significant effect. Conclusion After 3 months of follow-up, rt-PA had a non-significant more increase of favorable outcome with increased risk of sICH and death than controls. Baseline NIHSS, BMI, and history of TIA or previous ischemic stroke were significant predictors of outcome after thrombolysis.

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“…Previous studies have predicted the outcome of AIS patients using only one or two factors, particularly the NIHSS score and age, which have been recognized as the most direct contributors to patient outcome (20). The NIHSS score indicates the degree of neurological function damage and is frequently used to determine the severity of the patient's condition on admission (21).…”

Section: Discussionmentioning

confidence: 99%

Outcome prediction for patients with anterior circulation acute ischemic stroke following endovascular treatment: A single‑center study

Liu

Zhou

et al. 2019

Exp Ther Med

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Previous studies have identified various factors associated with the outcomes of acute ischemic stroke (AIS) but considered only 1 or 2 predictive factors. The present study aimed to use outcome-related factors derived from biochemical, imaging and clinical data to establish a logistic regression model that can predict the outcome of patients with AIS following endovascular treatment (EVT). The data of 118 patients with anterior circulation AIS (ACAIS) who underwent EVT between October 2014 and August 2018 were retrospectively analyzed. The patients were divided into 2 groups based on the modified Rankin Scale score at three months after surgery, where 0–2 points were considered to indicate a favorable outcome and 3–6 points were considered a poor outcome. Non-conditional logistic stepwise regression was used to identify independent variables that were significantly associated with patient outcome, which were subsequently used to establish a predictive statistical model, receiver operating characteristic (ROC) curve was used to show the performance of statistical model and analyze the specific association between each factor and outcome. Among the 118 patients, 47 (39.83%) exhibited a good and 71 (60.17%) exhibited a poor outcome. Multivariate analysis revealed that the predictive model was statistically significant (χ2=78.92; P<0.001), and that the predictive accuracy of the model was 83.1%, which was higher compared with that obtained using only a single factor. ROC curve analysis shows the area under curve of the statistical model was 0.823, the analysis of diagnostic threshold for prognostic factors indicated that age, diffusion-weighted imaging lesion volume, glucose on admission, National Institutes of Health Stroke Scale score on admission and hypersensitive C-reactive protein were valuable predictive factors for the outcome of EVT (P<0.05). In conclusion, a predictive model based on non-conditional logistic stepwise regression analysis was able to predict the outcome of EVT for patients with ACAIS.

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Simple prediction model for unfavorable outcome in ischemic stroke after intravenous thrombolytic therapy

Cited by 11 publications

References 15 publications

Additional factors to corelate with a more than 30% NIHSS score improvement in patients 7 days after fibrinolytic and/or endovascular treatment for ischemic stroke

Additional factors to corelate with a more than 30% NIHSS score improvement in patients 7 days after fibrinolytic and/or endovascular treatment for ischemic stroke

Short-term outcome in ischemic stroke patients after thrombolytic therapy

Outcome prediction for patients with anterior circulation acute ischemic stroke following endovascular treatment: A single‑center study

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