Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Clin Neurol Neurosurg. 2021 Sep;208:106830. doi: 10.1016/j.clineuro.2021.106830. Epub 2021 Jul 21.
There is controversy regarding Alberta Stroke Program Early CT Score (ASPECTS) and platelet indices as predictors of outcome in patients with acute ischemic stroke (AIS). We aimed to assess the prognostic value of ASPECTS, mean platelet volume (MPV), plateletcrit (PCT), and platelet count (Plt) in 3-month and 1-year functional outcomes of AIS patients, both independently and in combination.
This prospective study was conducted in Shams Al-shomuos and Ghaem hospitals of Mashhad, Iran from June 2019 to January 2021. Overall, 553 patients above 18 years old with first-ever anterior circulation AIS met the eligibility criteria and were included. Clinical, hematologic, radiologic, and demographic data of patients were recorded at baseline. The 3-month and 1-year functional outcome was evaluated by modified Rankin Scale (mRS). Multivariate logistic regression was used to determine the independent predictors of poor functional outcome (mRS>2) and mortality.
The mean age of the patients was 65.50 ± 14.41 years and 282 patients (51%) were male. ASPECTS ≤ 7 was an independent predictor of both poor function (OR=1.94, 95%CI=1.04-3.62, P = 0.04) and mortality (OR=2.02, 95%CI=1.14-3.58, P = 0.02) at 1 year. MPV was also a strong predictor of 3-month (OR=3.88, 95%CI=2.04-7.38, P = 0.02) and 1-year (OR=3.32, 95%CI=1.91-5.78, P = 0.01) mortality, as well as 3-month (OR=3.25, 95%CI=1.80-5.86, P < 0.001) and 1-year (OR=4.35, 95%CI=2.36-8.02, P < 0.001) poor function. For 1-year poor function (OR=9.33, 95%CI=2.19-39.73, P = 0.003) and mortality (OR=6.40, 95%CI=2.09-19.64, P = 0.001), ASPECTS combined with all platelet indices found to be a more robust independent predictor compared to each variable alone.
Although MPV is an independent predictor of both 3-month and 1-year poor function and mortality in AIS patients, ASPECTS ≤ 7 was found to be a risk factor for 1-year poor function and mortality. Moreover, the prognostic value of both platelet indices and ASPECTS are greater when they are combined together in AIS patients.
在急性缺血性脑卒中（AIS）患者中， Alberta 卒中项目早期 CT 评分（ASPECTS）和血小板指标作为预后预测因子存在争议。我们旨在评估 ASPECTS、平均血小板体积（MPV）、血小板压积（PCT）和血小板计数（Plt）在 AIS 患者 3 个月和 1 年功能结局中的预后价值，包括独立评估和联合评估。
本前瞻性研究于 2019 年 6 月至 2021 年 1 月在伊朗马什哈德的 Shams Al-shomuos 和 Ghaem 医院进行。共有 553 名符合条件的首次前循环 AIS 成年患者入组。患者的临床、血液学、影像学和人口统计学数据在基线时记录。采用改良 Rankin 量表（mRS）评估患者 3 个月和 1 年的功能结局。多变量逻辑回归用于确定预后不良（mRS>2）和死亡率的独立预测因素。
患者的平均年龄为 65.50±14.41 岁，282 名患者（51%）为男性。ASPECTS≤7 是 1 年时功能不良（OR=1.94，95%CI=1.04-3.62，P=0.04）和死亡率（OR=2.02，95%CI=1.14-3.58，P=0.02）的独立预测因素。MPV 也是 3 个月（OR=3.88，95%CI=2.04-7.38，P=0.02）和 1 年（OR=3.32，95%CI=1.91-5.78，P=0.01）死亡率以及 3 个月（OR=3.25，95%CI=1.80-5.86，P<0.001）和 1 年（OR=4.35，95%CI=2.36-8.02，P<0.001）不良功能的强烈预测因素。对于 1 年的不良功能（OR=9.33，95%CI=2.19-39.73，P=0.003）和死亡率（OR=6.40，95%CI=2.09-19.64，P=0.001），与每个变量单独评估相比，ASPECTS 联合所有血小板指标被发现是更强大的独立预测因素。
尽管 MPV 是 AIS 患者 3 个月和 1 年不良功能和死亡率的独立预测因素，但 ASPECTS≤7 是 1 年不良功能和死亡率的危险因素。此外，在 AIS 患者中，当血小板指数和 ASPECTS 联合使用时，其预后价值更大。
