Wang Ying, Liu Dongwei, Aldhabi Mokhtar, Chen Zuolei, Feng Le, Gao Huanmin, Yin Lin
Department of Neurology, The Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116023, Liaoning, China.
The Affiliated Hospital of Qingdao Binhai University, Qingdao, 266300, Shandong, China.
Sci Rep. 2025 Jan 8;15(1):1354. doi: 10.1038/s41598-024-84912-0.
To develop and validate practical prediction tools to estimate poor outcomes in patients ≥ 80 years old with acute ischemic stroke after intravenous alteplase thrombolysis, aiding clinical decision-making.To explore the longest benefit window after thrombolysis in the elderly. 1: A retrospectively analysis was conducted on acute stroke patients who underwent intravenous thrombolysis. Patients aged ≥ 80 years were compared to those aged 60-79 years, with a focus on the incidence of symptomatic intracranial hemorrhage, mortality, and poor functional outcome (modified Rankin Score ≥ 2 at 90 days post-thrombolysis). R software was utilized to develop a clinical prediction model and perform internal validation. 2: Ninety days, 180 days, and one year were designated as follow-up time points for all patients. 1.Patients aged ≥ 80 years had higher 90-day poor outcome and mortality (P < 0.001).However, there was no significant difference in symptomatic intracranial hemorrhage between the two groups (P > 0.05).Baseline NIHSS score (OR, 1.15; 95% CI,1.07-1.23; P < 0.001) and admission blood glucose (OR, 1.36; 95% CI,1.11-1.74; P = 0.007) were identified as independent predictors of poor prognosis at 90 days.The area of the prediction model under the receiver operator characteristic curve was 0.77. An online prognostic calculator was developed.2.There was no further improvement in mRS Score in the elderly group after 180days (P < 0.05). (1)The prediction model can estimate the poor outcome of patients aged ≥ 80 years with acute ischemic stroke after intravenous alteplase thrombolysis.The predictors are readily derived at admission.The prediction calculator( https://80ivtr.shinyapps.io/dynnomapp/ ) can be used as a popular tool for physicians. (2)The total duration of benefit after intravenous thrombolysis for patients aged ≥ 80 years is 180 days, while it is at least 1 year for patients between 60 and 79 years.
开发并验证实用的预测工具，以估计≥80岁急性缺血性卒中患者静脉注射阿替普酶溶栓后的不良预后，辅助临床决策。探索老年人溶栓后的最长获益窗口。1：对接受静脉溶栓的急性卒中患者进行回顾性分析。将年龄≥80岁的患者与60 - 79岁的患者进行比较，重点关注症状性颅内出血的发生率、死亡率和不良功能结局（溶栓后90天改良Rankin评分≥2分）。利用R软件开发临床预测模型并进行内部验证。2：将所有患者的随访时间点设定为90天、180天和1年。1.年龄≥80岁的患者90天不良结局和死亡率更高（P < 0.001）。然而，两组之间症状性颅内出血无显著差异（P > 0.05）。基线美国国立卫生研究院卒中量表（NIHSS）评分（OR，1.15；95%CI，1.07 - 1.23；P < 0.001）和入院血糖（OR，1.36；95%CI，1.11 - 1.74；P = 0.007）被确定为90天不良预后的独立预测因素。预测模型在受试者工作特征曲线下的面积为0.77。开发了一个在线预后计算器。2.180天后老年组改良Rankin量表（mRS）评分无进一步改善（P < 0.05）。（1）该预测模型可估计≥80岁急性缺血性卒中患者静脉注射阿替普酶溶栓后的不良预后。预测因素在入院时即可轻松得出。预测计算器（https://80ivtr.shinyapps.io/dynnomapp/ ）可作为医生常用的工具。（2）≥80岁患者静脉溶栓后的总获益持续时间为180天，而60 - 79岁患者至少为1年。
