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. 2023 Sep 21:14:1266526.
doi: 10.3389/fneur.2023.1266526. eCollection 2023.

CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury

Huijuan Jin  1 , Rentang Bi  1 , Yifan Zhou  1 , Qinghui Xiao  1 , Min Li  2 , Shuai Sun  1 , Jinghua Zhou  3 , Jichuan Hu  4 , Ming Huang  5 , Yanan Li  1 , Candong Hong  1 , Shengcai Chen  1 , Jiang Chang  6 , Yan Wan  1 , Bo Hu  1
Affiliations

CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury

Huijuan Jin et al. Front Neurol. .

Abstract

Importance: Early neurological deterioration (END) is a critical complication in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis (IVT), with a need for reliable prediction tools to guide clinical interventions.

Objective: This study aimed to develop and validate a rating scale, utilizing clinical variables and multisystem laboratory evaluation, to predict END after IVT.

Design setting and participants: The Clinical Trial of Revascularization Treatment for Acute Ischemic Stroke (TRAIS) cohort enrolled consecutive AIS patients from 14 stroke centers in China (Jan 2018 to Jun 2022).

Outcomes: END defined as NIHSS score increase >4 points or death within 24 h of stroke onset.

Results: 1,213 patients (751 in the derivation cohort, 462 in the validation cohort) were included. The CNS-LAND score, a 9-point scale comprising seven variables (CK-MB, NIHSS score, systolic blood pressure, LDH, ALT, neutrophil, and D-dimer), demonstrated excellent differentiation of END (derivation cohort C statistic: 0.862; 95% CI: 0.796-0.928) and successful external validation (validation cohort C statistic: 0.851; 95% CI: 0.814-0.882). Risk stratification showed END risks of 2.1% vs. 29.5% (derivation cohort) and 2.6% vs. 31.2% (validation cohort) for scores 0-3 and 4-9, respectively.

Conclusion: CNS-LAND score is a reliable predictor of END risk in AIS patients receiving IVT.

Keywords: acute ischemic stroke; clinical interventions; early neurological deterioration; intravenous thrombolysis; scale.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient inclusion in the study. A total of 1,425 patients with acute ischemic stroke (AIS) received intravenous thrombolysis (IVT) in the TRAIS study. Of these, 126 patients were excluded because they received endovascular therapy. After excluding an additional 86 patients due to lack of clinical data, a total of 1,213 patients were included in the final analysis. The patients were divided into two cohorts: a derivation cohort consisting of 751 patients from Wuhan Union Hospital, and a validation cohort consisting of 462 patients from 13 other hospitals.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve comparing the discrimination ability of CNS-LAND and 3 existing AIS prognostic scores for predicting END. The analysis was based on the validation cohort. The ROC curve demonstrates the trade-off between sensitivity and specificity for each prediction score, with a larger AUC indicating better discrimination ability.
See this image and copyright information in PMC

References

    1. Yu WM, Abdul-Rahim AH, Cameron AC, Kõrv J, Sevcik P, Toni D, et al. . The incidence and associated factors of early neurological deterioration after thrombolysis: results from SITS registry. Stroke. (2020) 51:2705–14. doi: 10.1161/STROKEAHA.119.028287, PMID: - DOI - PubMed
    1. Shkirkova K, Saver JL, Starkman S, Wong G, Weng J, Hamilton S, et al. . Frequency, predictors, and outcomes of prehospital and early Postarrival neurological deterioration in acute stroke: exploratory analysis of the FAST-MAG randomized clinical trial. JAMA Neurol. (2018) 75:1364–74. doi: 10.1001/jamaneurol.2018.1893, PMID: - DOI - PMC - PubMed
    1. Seners P, Turc G, Tisserand M, Legrand L, Labeyrie M-A, Calvet D, et al. . Unexplained early neurological deterioration after intravenous thrombolysis: incidence, predictors, and associated factors. Stroke. (2014) 45:2004–9. doi: 10.1161/STROKEAHA.114.005426, PMID: - DOI - PubMed
    1. Broccolini A, Brunetti V, Colò F, Alexandre AM, Valente I, Falcou A, et al. . Early neurological deterioration in patients with minor stroke due to isolated M2 occlusion undergoing medical management: a retrospective multicenter study. J Neurointerv Surg. (2023). doi: 10.1136/jnis-2023-020118 - DOI - PubMed
    1. Yu AYX, Hill MD, Coutts SB. Should minor stroke patients be thrombolyzed? A focused review and future directions. Int J Stroke. (2015) 10:292–7. doi: 10.1111/ijs.12426, PMID: - DOI - PubMed