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. 2023 Dec;43(12):2049-2059.
doi: 10.1177/0271678X231200117. Epub 2023 Sep 5.

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

Tian Tian  1 , Lanjing Wang  2   3 , Jiali Xu  2   3 , Yujie Jia  1 , Kun Xue  1 , Shuangfeng Huang  2   3 , Tong Shen  3 , Yumin Luo  3 , Sijie Li  2   3   4 , Lianqiu Min  1
Affiliations

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

Tian Tian et al. J Cereb Blood Flow Metab. 2023 Dec.

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.

Keywords: Acute ischemic stroke; early neurological deterioration; intravenous thrombolysis; nomogram; prediction model.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Nomogram for the prediction of ENDi in the AIS patients treated with IVT.
Figure 2.
Figure 2.
ROC curves. (a) Derivation cohort and (b) Validation cohort.
Figure 3.
Figure 3.
Calibration curves of the nomogram model. (a) Derivation cohort and (b) Validation cohort.
Figure 4.
Figure 4.
Decision curve analysis of the nomogram model. (a) Derivation cohort and (b) Validation cohort.
See this image and copyright information in PMC

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