Clinical and Imaging Risk Factors for Early Neurological Deterioration and Long-Term Neurological Disability in Patients with Single Subcortical Small Infarction

Abstract

Introduction: This study aims to evaluate the clinical and imaging risk factors for early neurological deterioration (END) and long-term neurological disability in patients with Single subcortical small infarction (SSSI). Methods: We retrospectively included SSSI patients hospitalized. Outcomes were defined as modified Rankin Scale (mRS) score >2 at follow-up and the occurrence of END during hospitalization. Multivariate logistic regression identified independent predictors of END and long-term outcomes. Stepwise regression analysis was used to develop a predictive model for poor outcomes. The predictive performance of risk factors and the model was assessed using receiver operating characteristic (ROC) curves. Results: A total of 289 SSSI patients were included. During hospitalization, 18 patients (6.2%) experienced END, and 29 patients (10%) had neurological disability at a median follow-up of 21.4 (16.7–25.2) months. Multivariate analysis showed the National Institutes of Health Stroke Scale (NIHSS) score (OR 1.438, 95% CI 1.182–1.749, P < 0.001), Total cholesterol (TC) (OR 1.545, 95% CI 1.014–2.355, P = 0.043), neutrophil to High density lipoprotein cholesterol ratio (NHR) (OR 1.371, 95% CI 1.074–1.75, P = 0.011), and neutrophil count (OR 1.333, 95% CI 1.025–1.733, P = 0.032) were independently associated with END. Age (OR 1.083, 95% CI 1.008–1.163, P = 0.029), lesion diameter (OR 1.121, 95% CI 1.001–1.255, P = 0.048), NIHSS (OR 1.685, 95% CI 1.33–2.134, P < 0.001), symptomatic intracranial artery stenosis (OR 6.655, 95% CI 1.618–27.38, P = 0.009), lacune grading (OR 3.644, 95% CI 1.468–9.048, P = 0.005), and The degree of brain atrophy (OR 2.232, 95% CI 1.199–4.154, P = 0.011) were independently associated with neurological disability. The predictive model for END (included NIHSS score and NHR level) and long-term neurological disability (included age, NIHSS score, symptomatic intracranial artery stenosis, number of lacunes, and brain atrophy) showed areas under the ROC curve of 0.836 and 0.926, respectively. Conclusion: High NIHSS, TC, NHR, and neutrophil count are independent risk factors for END. Age, NIHSS, lesion size, symptomatic intracranial artery stenosis, the degree of lacunes and brain atrophy are predictors of neurological disability in SSSI patients.