Neuroscience Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal (R.V., J.F., B.P., V.A., L.I., J.L., J.S., J.P.F., M.J.M., D.G., R. Antunes, J.P.R., R.F., M.C., L.F.M.).
Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (F.G.-O., I.Y., H.Z., T.K.K., K.B.).
Stroke. 2024 Sep;55(9):2353-2358. doi: 10.1161/STROKEAHA.123.046117. Epub 2024 Jul 25.
Large vessel occlusion acute ischemic stroke prognosis improved following the 2015 endovascular therapy (EVT) trials. Blood-based biomarkers may improve outcome prediction. We aimed to assess plasma brain-derived tau (BD-Tau) performance in predicting post-EVT large vessel occlusion acute ischemic stroke outcomes.
We included 2 temporally independent prospective cohorts of anterior circulation in patients with large vessel occlusion acute ischemic stroke who successfully recanalized post-EVT. We measured plasma BD-Tau, GFAP (glial-fibrillary-acidic-protein), NfL (neurofilament-light-chain), and total-Tau upon admission, immediately, 24 hours, and 72 hours post-EVT. Twenty-four-hour neuroimaging and 90-day functional outcomes were independently assessed using the Alberta Stroke Program Early Computed Tomography Score (good outcome: >7 or unchanged) and the modified Rankin Scale (favorable outcome <3 or unchanged), respectively. Based on the first cohort (derivation), we built a multivariable logistic regression model to predict a 90-day functional outcome. Model results were evaluated using the second cohort (evaluation).
In the derivation cohort (n=78, mean age=72.9 years, 50% women), 62% of patients had a good 24-hour neuroimaging outcome, and 45% had a favorable 90-day functional outcome. GFAP admission-to-EVT rate-of-change was the best predictor for early neuroimaging outcome but not for 90-day functional outcome. At admission, BD-Tau levels presented the highest discriminative performance for 90-day functional outcomes (area under the curve, 0.76 [95% CI, 0.65-0.87]; <0.001). The model incorporating age, admission BD-Tau, and 24-hour Alberta Stroke Program Early Computed Tomography Score achieved excellent discrimination of 90-day functional outcome (area under the curve, 0.89 [95% CI, 0.82-0.97]; <0.001). The score's predictive performance was maintained in the evaluation cohort (n=66; area under the curve, 0.82 [95% CI, 0.71-0.92]; <0.001).
Admission plasma BD-Tau accurately predicted 90-day functional outcomes in patients with large vessel occlusion acute ischemic stroke after successful EVT. The proposed model may predict functional outcomes using objective measures, minimizing human-related biases and serving as a simplified prognostic tool for AIS.
2015 年血管内治疗（EVT）试验后，大血管闭塞性急性缺血性卒中的预后得到改善。基于血液的生物标志物可能改善预后预测。我们旨在评估血浆脑源性 tau（BD-Tau）在预测 EVT 后大血管闭塞性急性缺血性卒中结局方面的性能。
我们纳入了两个时间独立的前瞻性队列，包括成功接受 EVT 后再通的前循环大血管闭塞性急性缺血性卒中患者。我们在入院时、EVT 后即刻、24 小时和 72 小时测量了血浆 BD-Tau、GFAP（胶质纤维酸性蛋白）、NfL（神经丝轻链）和总 Tau。24 小时神经影像学和 90 天功能结局分别使用 Alberta 卒中项目早期计算机断层扫描评分（良好结局：>7 或不变）和改良 Rankin 量表（有利结局<3 或不变）进行独立评估。基于第一个队列（推导），我们构建了一个多变量逻辑回归模型来预测 90 天的功能结局。使用第二个队列（评估）评估模型结果。
在推导队列（n=78，平均年龄 72.9 岁，50%为女性）中，62%的患者 24 小时神经影像学结局良好，45%的患者 90 天功能结局良好。GFAP 从入院到 EVT 的变化率是早期神经影像学结局的最佳预测因素，但不是 90 天功能结局的最佳预测因素。入院时，BD-Tau 水平对 90 天功能结局的预测能力最高（曲线下面积，0.76[95%CI，0.65-0.87]；<0.001）。纳入年龄、入院时 BD-Tau 和 24 小时 Alberta 卒中项目早期计算机断层扫描评分的模型实现了 90 天功能结局的出色区分（曲线下面积，0.89[95%CI，0.82-0.97]；<0.001）。该评分在评估队列（n=66）中的预测性能保持不变（曲线下面积，0.82[95%CI，0.71-0.92]；<0.001）。
成功 EVT 后，入院时的血浆 BD-Tau 能准确预测大血管闭塞性急性缺血性卒中患者的 90 天功能结局。该模型可以使用客观指标预测功能结局，最大限度地减少人为偏差，并作为 AIS 的简化预后工具。
