Han Qiao, You Shoujiang, Maeda Toshiki, Wang Yanan, Ouyang Menglu, Li Qiang, Song Lili, Zhao Yang, Ren Xinwen, Chen Chen, Delcourt Candice, Zhou Zien, Cao Yongjun, Liu Chun-Feng, Zheng Danni, Arima Hisatomi, Robinson Thompson G, Chen Xiaoying, Lindley Richard I, Chalmers John, Anderson Craig S, Wang Xia
Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China,
Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China,
Cerebrovasc Dis. 2025;54(2):175-183. doi: 10.1159/000539322. Epub 2024 May 15.
We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).
END and DND (without END) were defined as scores of a ≥2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a ≥1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).
Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001).
We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.
我们旨在确定参与国际强化高血压控制与溶栓治疗卒中研究（ENCHANTED）的急性缺血性卒中（AIS）患者早期神经功能恶化（END）和延迟神经功能恶化（DND）的预测因素及其与功能结局的关联。
END和DND（无END情况）分别定义为从基线到24小时和24至72小时，美国国立卫生研究院卒中量表（NIHSS）评分增加≥2分或格拉斯哥昏迷量表评分降低≥1分或死亡。多变量逻辑回归模型用于确定END和DND的独立预测因素及其与90天结局的关联（改良Rankin量表[mRS]二分法评分2 - 6分与0 - 1分、3 - 6分与0 - 2分以及死亡）。
在4496例患者中，分别有871例（19.4%）和302例（8.4%）患者发生END和DND。较高的基线NIHSS评分、老年、因严重动脉粥样硬化导致的大动脉闭塞、心源性栓塞性卒中亚型、24小时内出血性梗死和脑实质血肿均是END（所有p≤0.01）和DND（所有p≤0.024）的独立预测因素。此外，较高的基线收缩压（BP）（比值比[OR] 1.07，95%置信区间[CI] 1.02 - 1.12）、24小时内较高的舒张压变异性（OR 1.07，95% CI 1.04 - 1.09）、来自亚洲的患者（OR 1.25，95% CI 1.03 - 1.52）是END的唯一独立预测因素。然而，亚洲种族与DND呈负相关（OR 0.64，95% CI 0.47 - 0.86）。24小时内出血性梗死和脑实质血肿是所有卒中亚型中END的关键预测因素。END和DND均与90天时不良功能结局相关（所有p < 0.001）。
我们确定了AIS溶栓后END和DND重叠且独特的人口统计学和临床预测因素。END和DND均预测90天时的不良结局。
