Simple prediction model for unfavorable outcome in ischemic stroke after intravenous thrombolytic therapy

ABSTRACT

Objective

We aimed to develop a model to predict unfavorable outcome in patients with acute ischemic stroke treated with intravenous thrombolytic therapy (IVT), based on simple variables present on admission.

Methods

Retrospective analysis of acute ischemic stroke patients treated with IVT in a hospital in Rio de Janeiro. Clinical and radiographic variables were selected for analysis. Multivariate logistic regression was used to develop a predictive model.

Results

We analyzed a total of 82 patients. Median National Institutes of Health Stroke Scale (NIHSS) on admission was 9 (3–22), 40.2% presented with a hyperdense artery sign (HAS), 62% had identifiable early parenchymal changes and 61.6% experienced a favorable outcome. An NIHSS score of > 12 on arrival, age > 70 and the presence of HAS were associated with the outcome, even after correction in a logistic regression model.

Conclusion

An NIHSS > 12 on arrival, presence of HAS and age > 70 years were predictors of unfavorable outcome at three months in patients with acute ischemic stroke treated with IVT.

RESUMO

Objetivo

Desenvolver um modelo para predizer desfecho desfavorável em pacientes com acidente vascular cerebral isquêmico (AVCi) agudo tratados com terapia trombolítica intravenosa (TTI), baseado em variáveis simples presentes à admissão.

Métodos

Análise retrospectiva de casos de AVCi tratados com TTI em um hospital no Rio de Janeiro. Variáveis clínicas e radiográficas foram selecionadas para análise. Foi utilizada regressão logística para desenvolver modelo preditivo.

Resultados

82 casos foram analisados. A mediana de escore de National Institutes of Health Stroke Scale (NIHSS) na admissão foi 9 (3–22), 40,2% se apresentaram com sinal da artéria hiperdensa (SAH), 62% possuíam alterações parenquimatosas precoces e 61,6% obtiveram um desfecho favorável. NIHSS > 12, idade > 70 e a presença de SAH foram associados com o desfecho, mesmo após correção em modelo de regressão logística.

Conclusão

NIHSS > 12, a presença de SAH e idade maior que 70 anos foram preditores de desfecho desfavorável em 3 meses em pacientes com AVCi tratados com TTI.

stroke - thrombolytic therapy - forecasting

acidente vascular cerebral - terapia trombolítica - previsões

• References

• 1 Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. doi:10.1161/STR.0b013e318284056a
• 2 Strbian D, Meretoja A, Ahlhelm FJ, Pitkäniemi J, Lyrer P, Kaste M et al. Predicting outcome of IV thrombolysis-treated ischemic stroke patients: the DRAGON score. Neurology. 2012;78(6):427-32. doi:10.1212/WNL.0b013e318245d2a9
• 3 Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF, Mariano DC et al. Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and Barthel Index in Brazil: the role of cultural adaptation and structured interviewing. Cerebrovasc Dis. 2009;27(2):119-22. doi:10.1159/000177918
• 4 Leys D, Pruvo JP, Godefroy O, Rondepierre P, Leclerc X. Prevalence and significance of hyperdense middle cerebral artery in acute stroke. Stroke. 1992;23(3):317-24. doi:10.1161/01.STR.23.3.317
• 5 Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355(9216):1670-4. doi:10.1016/S0140-6736(00)02237-6
• 6 Sato S, Toyoda K, Uehara T, Toratani N, Yokota C, Moriwaki H et al. Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes. Neurology. 2008;70(24 Pt 2):2371-7. doi:10.1212/01.wnl.0000304346.14354.0b
• 7 Fischer U, Arnold M, Nedeltchev K, Brekenfeld C, Ballinari P, Remonda L et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke. 2005;36(10):2121-5. doi:10.1161/01.STR.0000182099.04994.fc
• 8 Menon BK, Puetz V, Kochar P, Demchuk AM. ASPECTS and other neuroimaging scores in the triage and prediction of outcome in acute stroke patients. Neuroimaging Clin N Am. 2011;21(2):407-23. doi:10.1016/j.nic.2011.01.007
• 9 Dharmasaroja PA, Muengtaweepongsa S, Dharmasaroja P. Intravenous thrombolysis in Thai patients with acute ischemic stroke: role of aging. J Stroke Cerebrovasc Dis. 2013;22(3):227-31. doi:10.1016/j.jstrokecerebrovasdis.2011.08.001
• 10 Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967-73. doi:10.1161/01.STR.0000258112.14918.24
• 11 Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA. 2015;314(17):1832-43. doi:10.1001/jama.2015.13767
• 12 Evaristo EF. Endovascular thrombectomy in acute ischemic stroke: a major breakthrough and a big challenge for Brazil. Arq Neuropsiquiatr. 2016;74(1):1-2. doi:10.1590/0004-282X20150209
• 13 Seiffge DJ, Karagiannis A, Strbian D, Gensicke H, Peters N, Bonati LH et al. Simple variables predict miserable outcome after intravenous thrombolysis. Eur J Neurol. 2014;21(2):185-91. doi:10.1111/ene.12254
• 14 Asuzu D, Nyström K, Amin H, Schindler J, Wira C, Greer D et al. TURN: A Simple Predictor of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocrit Care. 2015;23(2):166-71. doi:10.1007/s12028-015-0131-z
• 15 Asuzu D, Nyström K, Schindler J, Wira C, Greer D, Halliday J et al. TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis. Neurocrit Care. 2015;23(2):172-8. doi:10.1007/s12028-015-0154-5