CNS-LAND评分：基于全身反应和损伤预测静脉溶栓后早期神经功能恶化
CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury.
作者信息
Jin Huijuan, Bi Rentang, Zhou Yifan, Xiao Qinghui, Li Min, Sun Shuai, Zhou Jinghua, Hu Jichuan, Huang Ming, Li Yanan, Hong Candong, Chen Shengcai, Chang Jiang, Wan Yan, Hu Bo
机构信息
Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurology, The Second People's Hospital of China Three Gorges University, Yichang, China.
出版信息
Front Neurol. 2023 Sep 21;14:1266526. doi: 10.3389/fneur.2023.1266526. eCollection 2023.
IMPORTANCE
Early neurological deterioration (END) is a critical complication in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis (IVT), with a need for reliable prediction tools to guide clinical interventions.
OBJECTIVE
This study aimed to develop and validate a rating scale, utilizing clinical variables and multisystem laboratory evaluation, to predict END after IVT.
DESIGN SETTING AND PARTICIPANTS
The Clinical Trial of Revascularization Treatment for Acute Ischemic Stroke (TRAIS) cohort enrolled consecutive AIS patients from 14 stroke centers in China (Jan 2018 to Jun 2022).
OUTCOMES
END defined as NIHSS score increase >4 points or death within 24 h of stroke onset.
RESULTS
1,213 patients (751 in the derivation cohort, 462 in the validation cohort) were included. The CNS-LAND score, a 9-point scale comprising seven variables (CK-MB, NIHSS score, systolic blood pressure, LDH, ALT, neutrophil, and D-dimer), demonstrated excellent differentiation of END (derivation cohort C statistic: 0.862; 95% CI: 0.796-0.928) and successful external validation (validation cohort C statistic: 0.851; 95% CI: 0.814-0.882). Risk stratification showed END risks of 2.1% vs. 29.5% (derivation cohort) and 2.6% vs. 31.2% (validation cohort) for scores 0-3 and 4-9, respectively.
CONCLUSION
CNS-LAND score is a reliable predictor of END risk in AIS patients receiving IVT.
重要性
早期神经功能恶化（END）是接受静脉溶栓治疗（IVT）的急性缺血性卒中（AIS）患者的一种关键并发症，需要可靠的预测工具来指导临床干预。
目的
本研究旨在开发并验证一种评分量表，利用临床变量和多系统实验室评估来预测IVT后的END。
设计、地点和参与者：急性缺血性卒中血管再通治疗临床试验（TRAIS）队列纳入了来自中国14个卒中中心的连续AIS患者（2018年1月至2022年6月）。
结局
END定义为卒中发作后24小时内美国国立卫生研究院卒中量表（NIHSS）评分增加>4分或死亡。
结果
纳入1213例患者（推导队列751例，验证队列462例）。CNS-LAND评分是一个9分制量表，包含七个变量（肌酸激酶同工酶MB、NIHSS评分、收缩压、乳酸脱氢酶、谷丙转氨酶、中性粒细胞和D-二聚体），显示出对END的良好区分能力（推导队列C统计量：0.862；95%置信区间：0.796-0.928）并成功进行了外部验证（验证队列C统计量：0.851；95%置信区间：0.814-0.882）。风险分层显示，对于0-3分和4-9分，推导队列的END风险分别为2.1%和29.5%，验证队列分别为2.6%和31.2%。
结论
CNS-LAND评分是接受IVT的AIS患者END风险的可靠预测指标。
Zotero 插件