Morgan E McKeown1, Ayush Prasad2, Jessica Kobsa2, Ilayda Top2, Samuel B Snider1, Chelsea Kidwell3, Bruce C V Campbell4, Stephen M Davis4, Geoffrey A Donnan4, Michael Lev5, Kevin N Sheth2, Nils Petersen2, W Taylor Kimberly6, Matthew B Bevers7. 1. Division of Neurocritical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 2. Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, New Haven, CT, USA. 3. Division of Cerebrovascular Diseases and Stroke, University of Arizona, Tucson, AZ, USA. 4. Department of Medicine and Neurology, Melbourne Brain Center at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. 5. Division of Emergency Radiology and Emergency Neuroradiology, Massachusetts General Hospital, Boston, MA, USA. 6. Division of Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA. 7. Division of Neurocritical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. mbevers@bwh.harvard.edu.
Abstract
BACKGROUND: Cerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acute stroke. METHODS: Patient-level data from six acute stroke clinical trials were combined with endovascular thrombectomy registries from two academic referral centers, generating a combined cohort of 1977 patients. MLS was extracted from the original trial data or measured on computed tomography or magnetic resonance imaging that was obtained a median of 47.0 h (interquartile range 27.0-75.1 h) after stroke onset. Logistic regression was performed to identify predictors of poor outcome and the minimal clinically relevant MLS threshold. RESULTS: The presence of MLS was a predictor of poor outcome, independent of baseline clinical and demographic factors (adjusted odds ratio 4.46, 95% confidence interval 3.56-5.59, p < 0.001). Examining the full range of MLS values identified, a value of greater than 3 mm was the critical threshold that significantly predicted poor outcome (adjusted odds ratio 3.20 [1.31-7.82], p = 0.011). CONCLUSIONS: These results show that the presence of MLS predicts poor outcome and, specifically, MLS value greater than 3 mm is an important threshold across a variety of clinical settings. These findings may have relevance for the design and interpretation of future trials for antiedema therapies.
BACKGROUND: Cerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acute stroke. METHODS: Patient-level data from six acute stroke clinical trials were combined with endovascular thrombectomy registries from two academic referral centers, generating a combined cohort of 1977 patients. MLS was extracted from the original trial data or measured on computed tomography or magnetic resonance imaging that was obtained a median of 47.0 h (interquartile range 27.0-75.1 h) after stroke onset. Logistic regression was performed to identify predictors of poor outcome and the minimal clinically relevant MLS threshold. RESULTS: The presence of MLS was a predictor of poor outcome, independent of baseline clinical and demographic factors (adjusted odds ratio 4.46, 95% confidence interval 3.56-5.59, p < 0.001). Examining the full range of MLS values identified, a value of greater than 3 mm was the critical threshold that significantly predicted poor outcome (adjusted odds ratio 3.20 [1.31-7.82], p = 0.011). CONCLUSIONS: These results show that the presence of MLS predicts poor outcome and, specifically, MLS value greater than 3 mm is an important threshold across a variety of clinical settings. These findings may have relevance for the design and interpretation of future trials for antiedema therapies.
Authors: Kevin N Sheth; Matthew M Yuen; Mercy H Mazurek; Bradley A Cahn; Anjali M Prabhat; Sadegh Salehi; Jill T Shah; Samantha By; E Brian Welch; Michal Sofka; Laura I Sacolick; Jennifer A Kim; Seyedmehdi Payabvash; Guido J Falcone; Emily J Gilmore; David Y Hwang; Charles Matouk; Barbara Gordon-Kundu; Adrienne Ward Rn; Nils Petersen; Joseph Schindler; Kevin T Gobeske; Lauren H Sansing; Gordon Sze; Matthew S Rosen; W Taylor Kimberly; Prantik Kundu Journal: Sci Rep Date: 2022-01-07 Impact factor: 4.996