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. 2024 Jun;13(3):563-581.
doi: 10.1007/s40120-024-00588-8. Epub 2024 Mar 1.

The Association Between National Institutes of Health Stroke Scale Score and Clinical Outcome in Patients with Large Core Infarctions Undergoing Endovascular Treatment

Lingyu Zhang #  1   2 , Jinfu Ma #  3 , Mengmeng Wang  1   2 , Lin Zhang  4 , Wenzhe Sun  3 , Honghong Ji  2   5 , Chengsong Yue  3 , Jiacheng Huang  3 , Wenjie Zi  3 , Fengli Li  3 , Changwei Guo  6 , Pengfei Wang  7
Affiliations

The Association Between National Institutes of Health Stroke Scale Score and Clinical Outcome in Patients with Large Core Infarctions Undergoing Endovascular Treatment

Lingyu Zhang et al. Neurol Ther. 2024 Jun.

Abstract

Introduction: This study aimed to analyze the association between baseline National Institutes of Health Stroke Scale (NIHSS) scores and clinical outcomes in patients with large core infarctions undergoing endovascular treatment (EVT), a relationship that remains unclear.

Methods: Data were obtained from the MAGIC study, a prospective multicenter cohort study focusing on patients with acute large core ischemic stroke. This analysis evaluated the impact of NIHSS scores on EVT outcomes in patients with large core infarctions. Primary outcome metrics included favorable outcomes (modified Rankin Scale [mRS] of 0-3 at 90 days), while secondary outcomes encompassed shifts in mRS scores, functional independence (mRS score of 0-2), mRS score of 0-4, and successful recanalization rates. Adverse events considered were symptomatic intracranial hemorrhage (sICH) and mortality.

Results: A total of 490 patients were enrolled in this study. Higher baseline NIHSS scores were inversely correlated with favorable outcomes (adjusted odds ratio [OR] in model 3, 0.848 [0.797-0.903], P < 0.001), particularly in patients with NIHSS scores above 20 (adjusted OR in model 3, 0.518 [0.306-0.878] vs. 0.290 [0.161-0.523]). Regarding adverse events, higher baseline NIHSS scores significantly correlated with increased 90-day mortality rates (adjusted OR in model 3, 1.129 [1.072-1.189], P < 0.001). This correlation became insignificant when baseline NIHSS scores exceeded 22. Additionally, baseline NIHSS scores partially mediated the association between age (indirect effect = - 0.0005, 19.39% mediated) and sex (indirect effect = 0.0457, 25.08% mediated) with the primary outcome.

Conclusions: The findings indicate that higher baseline NIHSS scores correlate with poorer outcomes and increased mortality, particularly when scores exceed 20. Moreover, age and sex indirectly influence favorable outcomes through their association with baseline NIHSS scores.

Keywords: Endovascular therapy; Large core infarctions; National Institutes of Health Stroke Scale score.

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Conflict of interest statement

Lingyu Zhang, Jinfu Ma, Mengmeng Wang, Lin Zhang, Wenzhe Sun, Honghong Ji, Chengsong Yue, Jiacheng Huang, Wenjie Zi, Fengli Li, Changwei Guo, Pengfei Wang have nothing to disclose.

Figures

Fig. 1
Fig. 1
Association of mortality at 90 days and National Institutes of Health Stroke score (NIHSS)
Fig. 2
Fig. 2
Relationship between baseline NIHSS with primary outcome and symptomatic intracranial hemorrhage (sICH). a Relationship between baseline NIHSS with primary outcome. b Relationship between baseline NIHSS with sICH in a restricted cubic spline model
Fig. 3
Fig. 3
Mediation analysis. a The effect of age on primary outcome can partially mediated via baseline NIHSS score. b The effect of sex on primary outcome can partially mediated via baseline NIHSS score. Unstandardized indirect effects were computed for each of 1000 bootstrapped samples, and the 95% confidence interval was computed by determining the indirect effects at the 2.5th and 97.5th percentiles. ACME average causal mediation effects (indirect effect), ADE average direct effects
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