Ozkara Burak B, Karabacak Mert, Kotha Apoorva, Aslan Alperen, Hamam Omar, Edpuganti Namratha, Hoseinyazdi Meisam, Wang Richard, Cristiano Brian C, Yedavalli Vivek S
Department of Neuroradiology, MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA.
Department of Neurosurgery, Mount Sinai Health System, 1468 Madison Avenue, New York, NY 10029, USA.
Neurol Int. 2023 Feb 3;15(1):225-237. doi: 10.3390/neurolint15010015.
Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0-3) or unfavorable functional outcome (mRS 4-6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group.
在成功实现血管再通的患者中，多项基线血液学和代谢实验室参数已被证明与急性缺血性卒中（AIS）的临床结局相关。然而，尚无研究直接探究严重卒中亚组内的这些关系。本研究的目的是确定因大血管闭塞导致严重AIS且已成功接受机械取栓治疗的患者中潜在的预测性临床、实验室和影像学生物标志物。这项单中心回顾性研究纳入了继发于大血管闭塞且初始美国国立卫生研究院卒中量表（NIHSS）评分≥21分并通过机械取栓成功实现血管再通的患者。通过回顾性分析，从电子病历中提取了人口统计学、临床和影像学数据，并从急诊科记录中获取了实验室基线参数。临床结局定义为90天时的改良Rankin量表（mRS）评分，分为良好功能结局（mRS 0-3）或不良功能结局（mRS 4-6）。采用多因素逻辑回归建立预测模型。共纳入53例患者。良好结局组26例，不良结局组27例。在多因素逻辑回归分析中，年龄和血小板计数（PC）被发现是不良结局的预测因素。模型1（仅年龄模型）、模型2（仅PC模型）和模型3（年龄和PC模型）的受试者工作特征（ROC）曲线下面积分别为0.71、0.68和0.79。这是第一项揭示PC升高是该特定组不良结局独立预测因素的研究。
