Jie Pu1, Huaiming Wang2, Mingyi Tu3, Wenjie Zi4, Yonggang Hao5, Dong Yang4, Wenhua Liu6, Yue Wan7, Yu Geng8, Min Lin9, Ping Jin10, Yunyun Xiong4, Gelin Xu4, Qin Yin11, Xinfeng Liu12. 1. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China; Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China. 2. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; Department of Neurology, The 89th Hospital of The People's Liberation Army, Weifang, Shandong, China. 3. Department of Neurology, Hubei Wuchang Hospital, Wuhan, Hubei, China. 4. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. 5. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China; Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. 6. Department of Neurology, Wuhan No.1 Hospital, Wuhan, Hubei, China. 7. Department of Neurology, Hubei Zhongshan Hospital, Wuhan, Hubei, China. 8. Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China. 9. Department of Neurology, Fuzhou General Hospital of The People's Liberation Army, Fuzhou, Fujian, China. 10. Department of Neurology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, Anhui, China. 11. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. Electronic address: yinqin9912@163.com. 12. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China; Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. Electronic address: xfliu2@vip.163.com.
Abstract
BACKGROUND AND PURPOSE: Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. METHODS: We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected. RNI was calculated by the following equation: (baseline NIHSS - 24-hour/7-day NIHSS)/baseline NIHSS × 100%. A modified Rankin Scale score of 0-2 at 90 days was defined as a favorable outcome. Multivariable logistic regression analysis was used to evaluate the relationship between RNI and 90-day outcome. Receiver operator characteristic curve analysis was performed to identify the predictive power and cutoff point of RNI for functional outcome. FINDINGS: A total of 568 patients were enrolled. Both 24-hour and 7-day RNI were independent predictors of 90-day outcome. The best cutoff points of 24-hour and 7-day RNI were 28% and 42%, respectively. Compared with those with 24-hour RNI of less than 28% and 7-day RNI of less than 42%, patients with 24-hour RNI of 28% or greater and 7-day RNI of 42% or greater had a 39.595-fold (95% confidence interval 22.388-70.026) increased probability of achieving 90-day favorable outcome. CONCLUSIONS: The combination of 24-hour and 7-day RNI very strongly predicts 90-day functional outcome in patients with acute anterior circulation LVOS who received EVT, and it can be used as an early accurate surrogate of long-term outcome.
BACKGROUND AND PURPOSE: Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. METHODS: We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected. RNI was calculated by the following equation: (baseline NIHSS - 24-hour/7-day NIHSS)/baseline NIHSS × 100%. A modified Rankin Scale score of 0-2 at 90 days was defined as a favorable outcome. Multivariable logistic regression analysis was used to evaluate the relationship between RNI and 90-day outcome. Receiver operator characteristic curve analysis was performed to identify the predictive power and cutoff point of RNI for functional outcome. FINDINGS: A total of 568 patients were enrolled. Both 24-hour and 7-day RNI were independent predictors of 90-day outcome. The best cutoff points of 24-hour and 7-day RNI were 28% and 42%, respectively. Compared with those with 24-hour RNI of less than 28% and 7-day RNI of less than 42%, patients with 24-hour RNI of 28% or greater and 7-day RNI of 42% or greater had a 39.595-fold (95% confidence interval 22.388-70.026) increased probability of achieving 90-day favorable outcome. CONCLUSIONS: The combination of 24-hour and 7-day RNI very strongly predicts 90-day functional outcome in patients with acute anterior circulation LVOS who received EVT, and it can be used as an early accurate surrogate of long-term outcome.
Authors: Vicky Chalos; Nadinda A M van der Ende; Hester F Lingsma; Maxim J H L Mulder; Esmee Venema; Simone A Dijkland; Olvert A Berkhemer; Albert J Yoo; Joseph P Broderick; Yuko Y Palesch; Sharon D Yeatts; Yvo B W E M Roos; Robert J van Oostenbrugge; Wim H van Zwam; Charles B L M Majoie; Aad van der Lugt; Bob Roozenbeek; Diederik W J Dippel Journal: Stroke Date: 2019-12-04 Impact factor: 7.914