7天美国国立卫生研究院卒中量表作为预测缺血性卒中患者血管内治疗后预后的替代标志物。
7-Day National Institutes of Health Stroke Scale as a surrogate marker predicting ischemic stroke patients' outcome following endovascular therapy.
作者信息
Lai Yuzheng, Jou Eric, Mofatteh Mohammad, Nguyen Thanh N, Ho Jamie Sin Ying, Diana Francesco, Dmytriw Adam A, He Jianfeng, Yan Wenshan, Chen Yiying, Yan Zile, Sun Hao, Yeo Leonard L, Chen Yimin, Zhou Sijie
机构信息
Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, Guangdong, China.
Nanhai District Hospital of Traditional Chinese Medicine of Foshan City, Foshan, 528000, Guangdong, China.
出版信息
Transl Neurosci. 2023 Oct 19;14(1):20220307. doi: 10.1515/tnsci-2022-0307. eCollection 2023 Jan 1.
BACKGROUND
Early neurological deterioration after endovascular thrombectomy (EVT) is associated with poor prognosis. National Institutes of Health Stroke Scale (NIHSS) score measured at 24 h after EVT may be a better outcome predictor than other methods that focus on changes in NIHSS. Nevertheless, clinical fluctuations in ischemic stroke patients during the immediate phase after symptoms onset are well recognized. Therefore, a delayed NIHSS evaluation may improve prognostic accuracy. We evaluate the 7-day NIHSS in predicting long-term patient outcomes after EVT.
METHODS
This was a multi-center retrospective cohort study of 300 consecutive ischemic stroke patients with large vessel occlusion who underwent EVT at three-stroke centers in China from August 2018 to March 2022. NIHSS was recorded on admission, pre-EVT, 24 h, and 7 days after EVT.
RESULTS
A total of 236 eligible patients were subdivided into two groups: 7-day NIHSS ≤6 and NIHSS >6 post-EVT. 88.29% achieved a favorable outcome (modified Rankin Scale 0-2) in the NIHSS ≤6 group compared to 15.20% in the NIHSS >6 group at 90 days, and an improved favorable outcome in the former group was observed after adjusting for potential confounding factors (adjusted odds ratio 39.7, 95% confidence interval, 17.5-89.7, < 0.001).
CONCLUSION
The 7-day NIHSS score may be a reliable predictor of 90-day stroke patient outcome after EVT.
背景
血管内血栓切除术（EVT）后早期神经功能恶化与预后不良相关。与其他关注美国国立卫生研究院卒中量表（NIHSS）变化的方法相比，EVT后24小时测量的NIHSS评分可能是更好的预后预测指标。然而，缺血性卒中患者在症状发作后的急性期临床波动是公认的。因此，延迟的NIHSS评估可能会提高预后准确性。我们评估了7天NIHSS对预测EVT后患者长期预后的价值。
方法
这是一项多中心回顾性队列研究，纳入了2018年8月至2022年3月在中国三个卒中中心接受EVT的300例连续的大血管闭塞性缺血性卒中患者。记录患者入院时、EVT前、EVT后24小时和7天的NIHSS评分。
结果
共236例符合条件的患者被分为两组：EVT后7天NIHSS≤6组和NIHSS>6组。90天时，NIHSS≤6组88.29%的患者获得了良好预后（改良Rankin量表0-2分），而NIHSS>6组这一比例为15.20%。在调整潜在混杂因素后，前一组的良好预后得到改善（调整后的优势比为39.7，95%置信区间为17.5-89.7，<0.001）。
结论
7天NIHSS评分可能是预测EVT后90天卒中患者预后的可靠指标。
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