Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Alberta, Canada.
Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.).
Stroke. 2021 Aug;52(9):2839-2845. doi: 10.1161/STROKEAHA.120.032364. Epub 2021 Jul 8.
Little is known about the combined effect of age and National Institutes of Health Stroke Scale (NIHSS) in endovascular treatment (EVT) for acute ischemic stroke due to large vessel occlusion, and it is not clear how the effects of baseline age and NIHSS on outcome compare to each other. The previously described Stroke Prognostication Using Age and NIHSS (SPAN) index adds up NIHSS and age to a 1:1 combined prognostic index. We added a weighting factor to the NIHSS/age SPAN index to compare the relative prognostic impact of NIHSS and age and assessed EVT effect based on weighted age and NIHSS.
We performed adjusted logistic regression with good outcome (90-day modified Rankin Scale score 0–2) as primary outcome. From this model, the coefficients for NIHSS and age were obtained. The ratio between the NIHSS and age coefficients was calculated to determine a weighted SPAN index. We obtained adjusted effect size estimates for EVT in patient subgroups defined by weighted SPAN increments of 3, to evaluate potential changes in treatment effect.
We included 1750/1766 patients from the HERMES collaboration (Highly Effective Reperfusion Using Multiple Endovascular Devices) with available age and NIHSS data. Median NIHSS was 17 (interquartile range, 13–21), and median age was 68 (interquartile range, 57–76). Good outcome was achieved by 682/1743 (39%) patients. The NIHSS/age effect coefficient ratio was ([−0.0032]/[−0.111])=3.4, which was rounded to 3, resulting in a weighted SPAN index defined as ([3×NIHSS]+age). Cumulative EVT effect size estimates across weighted SPAN subgroups consistently favored EVT, with a number needed to treat ranging from 5.3 to 8.7.
The impact on chance of good outcome of a 1-point increase in NIHSS roughly corresponded to a 3-year increase in patient age. EVT was beneficial across all weighted age/NIHSS subgroups.
由于大血管闭塞导致的急性缺血性脑卒中，对于血管内治疗（EVT），我们对年龄和美国国立卫生研究院卒中量表（NIHSS）联合作用的了解甚少，并且尚不清楚基线年龄和 NIHSS 对预后的影响孰轻孰重。之前描述的卒中预后评分（SPAN）指数将 NIHSS 与年龄相加得到 1:1 的联合预后指数。我们在 NIHSS/年龄 SPAN 指数中添加了一个权重因子，以比较 NIHSS 和年龄的相对预后影响，并根据加权年龄和 NIHSS 评估 EVT 效果。
我们进行了调整后的逻辑回归分析，将 90 天改良 Rankin 量表评分 0-2 作为主要结局。从该模型中获得 NIHSS 和年龄的系数。计算 NIHSS 和年龄系数之间的比值，以确定加权 SPAN 指数。我们根据加权 SPAN 增量 3 确定患者亚组，以评估潜在的治疗效果变化，并获得 EVT 的调整后效应大小估计值。
我们纳入了 HERMES 协作（高有效性再灌注使用多种血管内设备）中具有年龄和 NIHSS 数据的 1750/1766 例患者。NIHSS 中位数为 17（四分位距，13-21），年龄中位数为 68（四分位距，57-76）。1743 例患者中有 682 例（39%）达到了良好结局。NIHSS/年龄效应系数比值为[（-0.0032）/（-0.111）]=3.4，四舍五入后为 3，得到加权 SPAN 指数定义为[（3×NIHSS）+年龄]。加权 SPAN 亚组的累积 EVT 效果大小估计值始终有利于 EVT，需要治疗的患者数量范围为 5.3 至 8.7。
NIHSS 增加 1 分对良好结局的机会影响大致相当于患者年龄增加 3 年。EVT 在所有加权年龄/NIHSS 亚组中均有益。
