Hallevi Hen, Albright Karen C, Martin-Schild Sheryl B, Barreto Andrew D, Morales Miriam M, Bornstein Natan, Ifejika Nneka L, Shuaib Ashfaq, Grotta James C, Savitz Sean I
Department of Neurology, Vascular Neurology Program, University of Texas at Houston Health Science Center, Houston, Texas 77030, USA.
Cerebrovasc Dis. 2009;28(4):341-8. doi: 10.1159/000229552. Epub 2009 Jul 24.
Ischemic stroke is a leading cause of morbidity. Assessing the chances of recovery is critical to optimize poststroke care.
We used a cohort of patients from the Virtual International Stroke Trial Archive that participated in acute stroke trials (control arm) and were followed for 90 days. The cohort was grouped by day 7 (D7) modified Rankin scale (mRS) scores. Variables that were associated with good outcome (mRS 0-2 at 90 days) in the univariate analysis were entered into a logistic regression model to determine the independent good outcome criteria for each D7 mRS tier.
We analyzed 1,798 patients. The independent good outcome criteria identified for different mRS tiers were: D7 mRS of 3: age < or =70, 0-2 vascular risk factors, D7 NIH Stroke Scale (NIHSS) arm strength < or =1, D7 NIHSS language score = 0; D7 mRS of 4: age < or =70, male, D7 NIHSS facial palsy < or =1, D7 NIHSS visual = 0, D7 NIHSS leg strength < or =1, D7 NIHSS dysarthria = 0; D7 mRS of 5: age < or =70, IV tPA treatment, D7 NIHSS dysarthria = 0, D7 NIHSS leg strength < or =2. For each mRS tier, we observed a graded increase in the percentage of the primary and secondary end points with increase in the number of criteria.
We identified clinical variables that predict good outcome, are specific to each day 7 mRS tier, and enable easy and informative assessment of the patient's likelihood of achieving varying degrees of recovery at day 90. These results may be useful in both clinical practice and research but require validation in an independent patient cohort.
缺血性中风是发病的主要原因。评估恢复的可能性对于优化中风后护理至关重要。
我们使用了来自虚拟国际中风试验档案库的一组患者，这些患者参与了急性中风试验（对照组）并随访了90天。该队列按第7天（D7）改良Rankin量表（mRS）评分进行分组。在单变量分析中与良好结局（90天时mRS 0 - 2）相关的变量被纳入逻辑回归模型，以确定每个D7 mRS层级的独立良好结局标准。
我们分析了1798例患者。为不同mRS层级确定的独立良好结局标准为：D7 mRS为3：年龄≤70岁，0 - 2个血管危险因素，D7美国国立卫生研究院卒中量表（NIHSS）上肢肌力≤1，D7 NIHSS语言评分 = 0；D7 mRS为4：年龄≤70岁，男性，D7 NIHSS面瘫≤1，D7 NIHSS视觉 = 0，D7 NIHSS下肢肌力≤1，D7 NIHSS构音障碍 = 0；D7 mRS为5：年龄≤70岁，静脉注射组织型纤溶酶原激活剂（IV tPA）治疗，D7 NIHSS构音障碍 = 0，D7 NIHSS下肢肌力≤2。对于每个mRS层级，我们观察到随着标准数量的增加，主要和次要终点的百分比呈分级增加。
我们确定了预测良好结局的临床变量，这些变量特定于每个第7天mRS层级，并且能够轻松且信息丰富地评估患者在90天时实现不同程度恢复的可能性。这些结果可能在临床实践和研究中都有用，但需要在独立的患者队列中进行验证。
