Prediction of Outcome in Patients With Acute Ischemic Stroke Based on Initial Severity and Improvement in the First 24 h

Abstract

IntroductionStroke severity measured by the baseline National Institutes of Health Stroke Scale (NIHSS) is a strong predictor of stroke outcome. Early change of baseline severity may be a better predictor of outcome. Here, we hypothesized that the change in NIHSS in the first 24 h after stroke improved stroke outcome prediction.Materials and methodsPatients from the Leuven Stroke Genetics Study were included when the baseline NIHSS (B-NIHSS) was determined on admission in the hospital and NIHSS after 24 h could be obtained from patient files. The delta NIHSS, relative reduction NIHSS, and major neurological improvement (NIHSS of 0–1 or ≥8-point improvement at 24 h) were calculated. Good functional outcome (GFO) at 90 days was defined as a modified Rankin Scale of 0–2. Independent predictors of outcome were identified by multivariate logistic regression. We performed a secondary analysis after excluding patients presenting with a minor stroke (NIHSS 0–5) since the assessment of change in NIHSS might be more reliable in patients presenting with a moderate to severe deficit.ResultsWe analyzed the outcome in 369 patients. B-NIHSS was associated with GFO (odds ratio: 0.82; 95% CI 0.77–0.86). In a multivariate model with B-NIHSS and age as predictors, the accuracy [area under the curve (AUC): 0.82] improved by including the delta NIHSS (AUC: 0.86; p < 0.01). In 131 patients with moderate to severe stroke, the predictive multivariate model was more accurate when including the RR NIHSS (AUC: 0.83) to the model which included B-NIHSS, age and ischemic heart disease (AUC: 0.77; p = 0.03).ConclusionB-NIHSS is a predictor of stroke outcome. In this cohort, the prediction of GFO was improved by adding change in stroke severity after 24 h to the model.

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“…On the other hand, according to the National Institutes of Health Stroke Scale (NIHSS), 24 hours post onset of symptoms is the time point at which the clinical condition must be assessed when evaluating the effects of a given treatment at the acute phase of stroke. Lending further support, neurological examination at 24 hours has also been reported to predict functional outcomes at 1 month and 90 days post stroke.…”

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“…NIHSS scores have shown to be predictive for any vessel occlusions in the anterior circulation, and cut-off values of NIHSS scores >7 from three to six hours of stroke onset provided a predictive value of 84.4% for worsening neurologic functions [22]. In another study [21], major neurological improvements were observed with a NIHSS score of below eight within 24 hours of stroke onset, while a score of ≤ 6 forecasts a favorable neurological recovery [23].…”

“…Patients with a National Institute of Health Stroke Scale (NIHSS) score of equal to or less than 7 at the time of admission demonstrate a higher likelihood of making positive neurological progress after an AIS, while NIHSS scores greater than 7 on admission demonstrated a higher probability of worsening neurological function in hemispheric strokes [19,20]. Therefore, the baseline NIHSS, stratified by NIHSS scores of ≤7 and >7 can be used to assess improvement or non-improvement following thrombolytic therapy for AIS [21,22]. NIHSS scores have shown to be predictive for any vessel occlusions in the anterior circulation, and cut-off values of NIHSS scores >7 from three to six hours of stroke onset provided a predictive value of 84.4% for worsening neurologic functions [22].…”

Cholesterol reducer and Thrombolytic therapy in acute ischemic stroke

“…In another study [21], NIHSS scores turned out to be predictive for any vessel occlusions in the anterior circulation, and cutoff values of NIHSS scores ≥ 7 of 3 to 6 hours of stroke onset provided a predictive value of 84.4% [21]. In another study [20], major neurological improvements were observed below NIHSS of 8 within 24 hours of stroke onset, while a score of < or = 6 forecasts a good recovery [22]. While low and high NIHSS cut-off points are effective predictors for good and poor outcomes, the NIHSS is heavily weighted towards hemispheric stroke [23].…”

“…Patients with a National Institute of Health Stroke Scale (NIHSS) score of equal to or less than 7 at the time of admission demonstrate a higher likelihood of making progress after an AIS, while scores greater than 7 on admission demonstrated a higher probability of worsening neurological function in hemispheric stroke [17,18]. Therefore, the baseline NIHSS, stratified by NIHSS scores of ≥ 7 for worsening neurologic functions and ≤ 7 for neurologic improvement can be used to assess improvement or non-improvement following thrombolytic therapy [19,20]. In another study [21], NIHSS scores turned out to be predictive for any vessel occlusions in the anterior circulation, and cutoff values of NIHSS scores ≥ 7 of 3 to 6 hours of stroke onset provided a predictive value of 84.4% [21].…”