Abstract
BackgroundFluid-attenuated inversion recovery vascular hyperintensity (FVH) can reflect the collateral status, which may be a valuable indicator to predict the functional outcome of acute stroke (AS) patients.MethodsA total of 190 AS patients with large vessel occlusion (LVO) were retrospectively investigated. All patients completed a 6-month follow-up and their modified Rankin Scale (mRS) scores were recorded at 1, 3, and 6 months after intravenous thrombolysis (IVT). Based on their mRS at 3 months, patients were divided into two groups: poor prognosis (131 patients; 68.9% of all subjects) and favorable prognosis (59 patients; 31.1% of all subjects). The death records of 28 patients were also analyzed in the poor prognosis group.Results(1) Univariate and multivariate analyses showed that the higher National Institutes of Health Stroke Scale (NIHSS) score at admission, higher fasting blood glucose, and lower FVH score were independent risk factors to predict the poor prognosis of IVT. (2) Survival analysis indicated that FVH score was the only baseline factor to predict the 6-month survival after IVT. (3) Baseline FVH score had great prediction performance for the prognosis of IVT (area under the curve = 0.853). (4) Baseline FVH score were negatively correlated with the NIHSS score at discharge and mRS score at 1, 3, and 6 months.ConclusionAmong various baseline clinical factors, only the FVH score might have implications for 3-month outcome and 6-month survival of AS patients after IVT. Baseline FVH score showed great potential to predict the prognosis of the AS patients.
Highlights
As shown by epidemiology analyses, stroke is the main cause of death in China, with the largest number of stroke cases worldwide, increasing the medical and nursing burden in this country (Wu et al, 2019; Roth and Mohamadzadeh, 2021)
The poor prognosis group showed significantly higher National Institutes of Health Stroke Scale (NIHSS) score at admission, systolic blood pressure, fasting blood glucose, serum creatinine, and serum hs-C-reactive protein (CRP), and significantly lower Fluid-attenuated inversion recovery vascular hyperintensity (FVH) score compared with the favorable prognosis group
The logistics analysis revealed that NIHSS score at admission (OR = 1.214, 95% confidence interval (CI) = 1.084 ∼ 1.361, P = 0.001), fasting blood glucose (OR = 1.385, 95% CI = 1.004 ∼ 1.911, P = 0.045), and FVH score (OR = 0.349, 95% CI = 0.245 ∼ 0.497, P < 0.001) were related to poor prognosis onset, and might serve as independent risk factors to predict poor prognosis in acute stroke (AS) patients receiving intravenous thrombolysis (IVT)
Summary
As shown by epidemiology analyses, stroke is the main cause of death in China, with the largest number of stroke cases worldwide, increasing the medical and nursing burden in this country (Wu et al, 2019; Roth and Mohamadzadeh, 2021). The baseline collaterals status may have an important effect on the prognosis and functional recovery after IVT in AS patients (Bang et al, 2015; Singer et al, 2015; Ravindran et al, 2021). Our previous study demonstrated that a higher FVH score based on the Alberta Stroke Program Early CT Score (ASPECTS) grading system was associated with better collaterals and functional outcome after endovascular therapy in AS patients with large vessel occlusion (LVO) (Jiang et al, 2019). The potential clinical value of FVH score after IVT in AS patients remains unclear, especially for the prediction of survival outcome of IVT. Fluid-attenuated inversion recovery vascular hyperintensity (FVH) can reflect the collateral status, which may be a valuable indicator to predict the functional outcome of acute stroke (AS) patients
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