Kniep Helge, Bechstein Matthias, Broocks Gabriel, Brekenfeld Caspar, Flottmann Fabian, van Horn Noel, Geest Vincent, Faizy Tobias D, Deb-Chatterji Milani, Alegiani Anna, Thomalla Götz, Gellißen Susanne, Fiehler Jens, Hanning Uta, Meyer Lukas
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Neurol. 2022 Nov;29(11):3296-3306. doi: 10.1111/ene.15519. Epub 2022 Aug 28.
Early surrogates for functional outcome in anterior circulation stroke have been described with the National Institute of Health Stroke Scale (NIHSS) at 24 h being reported as the most accurate metric. We compare discriminatory power of established definitions of early neurological improvement (ENI) and NIHSS scores at admission and 24 h to predict functional outcome at 90 days after thrombectomy in posterior circulation stroke (PCS).
All patients enrolled in the German Stroke Registry (June 2015-December 2019) with PCS and at least vertebral or basilar artery occlusions were included. NIHSS admission, 24 h and ENI definitions (improvement of 8/10 NIHSS points or 0/1 NIHSS points at 24 h) were compared for predicting functional outcome at 90 days. Favourable and good outcome were defined as modified Rankin Scale (mRS) 0-2 and 0-3. Multivariable logistic regression analysis was conducted to identify factors impairing predictive power.
Three hundred and eighty-seven patients were included. NIHSS 24 h had the highest discriminative power with receiver operator characteristics area under the curve of 0.87 (95% confidence interval: 0.83; 0.90) for good and 0.89 (0.85; 0.92) for favourable outcome; optimal cut-off values were ≤9 and ≤5. Higher age (odds ratio = 1.10 [1.05; 1.16]), adverse events during treatment (9.46 [1.52; 72.5]) and until discharge (18.34 [2.33; 172]) and high NIHSS scores at 24 h (1.29 [1.10; 1.53]) were independent predictors for turning the outcome prognosis from good (mRS ≤3) to poor (mRS ≥4).
NIHSS 24 h ≤9 points serves best as surrogate for good functional outcome after thrombectomy in PCS. Advanced age, severe neurological symptoms at admission and adverse events decrease its predictive value.
已有研究描述了前循环卒中功能结局的早期替代指标，其中24小时美国国立卫生研究院卒中量表（NIHSS）被报道为最准确的指标。我们比较了已确立的早期神经功能改善（ENI）定义以及入院时和24小时时的NIHSS评分在预测后循环卒中（PCS）血管内血栓清除术后90天功能结局方面的鉴别能力。
纳入德国卒中登记处（2015年6月至2019年12月）中所有患有PCS且至少存在椎动脉或基底动脉闭塞的患者。比较入院时、24小时时的NIHSS评分以及ENI定义（24小时内NIHSS评分改善8/10分或0/1分）对90天功能结局的预测情况。良好结局和优结局分别定义为改良Rankin量表（mRS）0 - 2分和0 - 3分。进行多变量逻辑回归分析以确定影响预测能力的因素。
共纳入387例患者。NIHSS 24小时评分具有最高的鉴别能力，预测优结局时曲线下面积为0.87（95%置信区间：0.83；0.90），预测良好结局时为0.89（0.85；0.92）；最佳截断值分别为≤9分和≤5分。年龄较大（比值比 = 1.10 [1.05；1.16]）、治疗期间（9.46 [1.52；72.5]）和出院前（18.34 [2.33；172]）出现不良事件以及24小时时NIHSS评分较高（1.29 [1.10；1.53]）是导致结局预后从良好（mRS≤3）转变为不良（mRS≥4）的独立预测因素。
在PCS血管内血栓清除术后，NIHSS 24小时评分≤9分最适合作为良好功能结局的替代指标。高龄、入院时严重神经症状以及不良事件会降低其预测价值。
