Prediction of early neurological deterioration in acute ischemic stroke patients treated with intravenous thrombolysis

Abstract

A proportion of acute ischemic stroke (AIS) patients suffer from early neurological deterioration (END) within 24 hours following intravenous thrombolysis (IVT), which greatly increases the risk of poor prognosis of these patients. Therefore, we aimed to explore the predictors of early neurological deterioration of ischemic origin (ENDi) in AIS patients after IVT and develop a nomogram prediction model. This study collected 244 AIS patients with post-thrombolysis ENDi as the derivation cohort and 155 patients as the validation cohort. To establish a nomogram prediction model, risk factors were identified by multivariate logistic regression analysis. The results showed that neutrophil to lymphocyte ratio (NLR) (OR 2.616, 95% CI 1.640–4.175, P < 0.001), mean platelet volume (MPV) (OR 3.334, 95% CI 1.351–8.299, P = 0.009), body mass index (BMI) (OR 1.979, 95% CI 1.285–3.048, P = 0.002) and atrial fibrillation (AF) (OR 8.012, 95% CI 1.341–47.873, P = 0.023) were significantly associated with ENDi. The area under the curve of the prediction model constructed from the above four factors was 0.981 (95% CI 0.961–1.000) and the calibration curve was close to the ideal diagonal line. Therefore, this nomogram prediction model exhibited good discrimination and calibration power and might be a reliable and easy-to-use tool to predict post-thrombolysis ENDi in AIS patients.

A Risk Prediction Model for Unexplained Early Neurological Deterioration Following Intravenous

“…Early prediction is crucial for effective doctor-patient communication and the timely implementation of preventive measures to reduce the incidence of END. Many indicators, such as aquaporin-4 levels or active N-terminal pro-brain natriuretic peptide levels, are typically obtained post-intravenous thrombolysis and are seldom measured in emergency settings [9][10][11] In many studies, it is noted that large artery disease 9,13 , coupled with a low ASPECTS 14,15 , can contribute to the occurrence of END. Large arterial lesions result in extensive ischemic tissue and potentially a signi cant ischemic penumbra.…”

Optimizing early neurological deterioration prediction in acute ischemic stroke patients following intravenous thrombolysis: a LASSO regression model approach

“…Specifically, the inclusion of past stroke history ( Li et al, 2020 ; Jin et al, 2023 ) is pivotal as it may indicate an underlying state of cerebral vascular health in patients. Body mass index (BMI) ( Tian et al, 2023 ) and onset-to-treatment time (OTT) ( Meng et al, 2023 ; Shi et al, 2023 ) are also critical variables, reflecting the overall health condition of the patient and the timeliness of treatment, respectively. These factors are essential for predicting the efficacy of treatment.…”

“…The risk factors for Early Neurological Deterioration post-Intravenous Thrombolysis (END post-IVT) are diverse, encompassing hypertension, diabetes mellitus, previous stroke history, and various biochemical markers ( Jin et al, 2023 ; Tian et al, 2023 ; Wang and Liu, 2023 ). Nevertheless, current predictive models for END following IVT have limitations, such as small sample sizes, regional constraints, or insufficient variable inclusion ( Nair et al, 2022 ; Wang L. et al, 2022 ; Luo et al, 2023 ; Yang et al, 2023 ).…”