Xu Yayun, Feng Haixing, Huang Zhengzheng, Li Yanlei, Chi Feng, Ren Lijie
Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, P. R. China.
Thromb J. 2025 Mar 10;23(1):21. doi: 10.1186/s12959-025-00704-0.
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the preferred treatment for acute ischemic stroke (AIS). Nevertheless, only approximately half of patients undergoing IVT experience positive outcomes. The objective of the study was to examine the clinical characteristics of patients with AIS and identify predictors for unfavorable clinical outcomes at 3 months after IVT. This retrospective cohort study comprised 3805 consecutive patients diagnosed with AIS who received IVT. Patients categorized as having a poor outcome were those with a modified Rankin scale score (mRS) of 3-6, while those categorized as having a good outcome had a score of 0-2. Clinical profiles and laboratory examinations were compared among patients with differing outcomes. A logistic regression model was utilized to investigate potential factors correlated with unfavorable outcomes. Of the 3805 patients included in the study, 3176 (83.5%) were found to have a good outcome, while 629 (16.5%) experienced an poor outcome following IVT. Advancing age (OR = 1.037, P < 0.001) and higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.156, P < 0.001) were significant independent predictors of a poor outcome. The area under curve (AUC) values for age, NIHSS score, and the combined effect of age and NIHSS score in predicting a poor response were 0.644, 0.761, and 0.777, respectively. Our research indicates that advancing age and higher baseline NIHSS score may serve as prognostic indicators for predicting early unfavorable outcomes following IVT in patients with AIS.
重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓是急性缺血性卒中（AIS）的首选治疗方法。然而，接受静脉溶栓治疗的患者中只有大约一半获得了良好的治疗效果。本研究的目的是探讨AIS患者的临床特征，并确定静脉溶栓治疗后3个月不良临床结局的预测因素。这项回顾性队列研究纳入了3805例连续诊断为AIS并接受静脉溶栓治疗的患者。改良Rankin量表评分（mRS）为3-6分的患者被归类为预后不良，而评分0-2分的患者被归类为预后良好。比较了不同预后患者的临床特征和实验室检查结果。采用逻辑回归模型研究与不良结局相关的潜在因素。在纳入研究的3805例患者中，3176例（83.5%）预后良好，而629例（16.5%）静脉溶栓治疗后预后不良。年龄增长（OR = 1.037，P < 0.001）和较高的基线美国国立卫生研究院卒中量表（NIHSS）评分（OR = 1.156，P < 0.001）是不良结局的显著独立预测因素。年龄、NIHSS评分以及年龄和NIHSS评分联合作用预测不良反应的曲线下面积（AUC）值分别为0.644、0.761和0.777。我们的研究表明，年龄增长和较高的基线NIHSS评分可能作为预测AIS患者静脉溶栓治疗后早期不良结局的预后指标。
