Department of Neurology, 12579Medical School of Southeast University, Jinling Hospital, China.
Stroke Center and Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, 12652University of Science and Technology of China, China.
Interv Neuroradiol. 2022 Aug;28(4):404-410. doi: 10.1177/15910199211038207. Epub 2021 Sep 13.
This study aims at exploring the 3-month outcome predicting ability of delayed neurological improvement and the cause of delayed neurological improvement.
Early neurological improvement and delayed neurological improvement were calculated to represent the neurological improvements. Good functional outcome was defined as a 90-day modified Rankin Scale score 0-2. We used multivariant logistic regression to explore the influential factors of good functional outcome as well as delayed neurological improvement. We applied net reclassification improvement and integrated discrimination improvement to assess the quantitative improvement of the predictive model.
Early neurological improvement was observed in 50 (23%) patients and delayed neurological improvement exhibited in 67 (30%) patients. Early neurological improvement and delayed neurological improvement were both independent predictive factors to good functional outcome. In the basic model (adjusted for age, admission glucose level, baseline National Institute of Health Stroke Scale, and complications and number of retrieval attempts), early neurological improvement and delayed neurological improvement statistically improved the predictive ability (early neurological improvement: net reclassification improvement = 0.34, 95% confidence interval, 95% confidential interval (0.06, 0.69); integrated discrimination improvement = 0.05, < 0.001; delayed neurological improvement: net reclassification improvement = 0.79, 95% confidential interval (0.47, 1.12); integrated discrimination improvement = 0.14, < 0.001) delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement (early neurological improvement vs. delayed neurological improvement: integrated discrimination improvement = 0.09, < 0.001). Moreover, delayed neurological improvement was affected by hypertension (odds ratio = 0.40, 95% CI (0.18, 0.88), = 0.02), early neurological improvement (odds ratio = 20.10, 95% confidential interval (8.24, 19.02), < 0.001), number of retrieval attempts (odds ratio = 0.39, 95% confidential interval (0.24, 0.66), < 0.001), and complication (odds ratio = 0.25, 95% confidential interval (0.12, 0.54), < 0.001).
Delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement. Hypertension, early neurological improvement, numbers of retrieval attempts, and complications were all predicting factors to delayed neurological improvement.
本研究旨在探讨迟发性神经功能恶化的 3 个月预后预测能力及其病因。
分别计算早期神经功能改善和迟发性神经功能改善以代表神经功能改善情况。良好的功能结局定义为 90 天改良 Rankin 量表评分 0-2。我们采用多变量逻辑回归探讨良好功能结局和迟发性神经功能改善的影响因素。我们应用净重新分类改善和综合鉴别改善来评估预测模型的定量改善。
50 例（23%）患者出现早期神经功能改善，67 例（30%）患者出现迟发性神经功能改善。早期神经功能改善和迟发性神经功能改善均为良好功能结局的独立预测因素。在基本模型（校正年龄、入院血糖水平、基线国立卫生研究院卒中量表以及并发症和取栓尝试次数）中，早期神经功能改善和迟发性神经功能改善均显著提高了预测能力（早期神经功能改善：净重新分类改善=0.34，95%置信区间（0.06，0.69）；综合鉴别改善=0.05，<0.001；迟发性神经功能改善：净重新分类改善=0.79，95%置信区间（0.47，1.12）；综合鉴别改善=0.14，<0.001），迟发性神经功能改善比早期神经功能改善更能准确预测临床结局（早期神经功能改善与迟发性神经功能改善：综合鉴别改善=0.09，<0.001）。此外，迟发性神经功能改善受高血压（比值比=0.40，95%置信区间（0.18，0.88），=0.02）、早期神经功能改善（比值比=20.10，95%置信区间（8.24，19.02），<0.001）、取栓尝试次数（比值比=0.39，95%置信区间（0.24，0.66），<0.001）和并发症（比值比=0.25，95%置信区间（0.12，0.54），<0.001）的影响。
迟发性神经功能改善比早期神经功能改善更能准确预测临床结局。高血压、早期神经功能改善、取栓尝试次数和并发症均为迟发性神经功能改善的预测因素。
