Prediction Of Neurological Outcome Research Articles

Variation in Candidate Traumatic Brain Injury Biomarker Genes Are Associated with Gross Neurological Outcomes after Severe Traumatic Brain Injury.

Diagnostic and prognostic biomarkers of traumatic brain injury (TBI) are actively being pursued; potential candidates include glial fibrillary acid protein (GFAP), S100 calcium-binding protein B (S100B), and ubiquitin C-terminal hydrolase L1 (UCHL1), two of which the United States Food and Drug Administration (FDA) recently approved for marketing of blood tests for adult concussion. The relationship between biomarker-encoding genes and TBI outcomes remains unknown. This pilot study explores variation in 18 single nucleotide polymorphisms (SNPs) in biomarker-encoding genes as predictors of neurological outcome in a population of adults with severe TBI. Participants (n = 305) were assessed using the Glasgow Outcome Scale (GOS) at 3, 6, 12, and 24 months post-injury. Multivariate logistical regression was used to calculate the odds ratio (OR) and determine the odds of having a lower score on the GOS ( = 1-2 vs. 3-5) based on variant allele presence, while controlling for confounders. Possession of the variant allele of one S100B SNP (rs1051169) was associated with higher scores on the GOS at 3 months (OR = 0.39; p = 0.04), 6 months (OR = 0.34; p = 0.02), 12 months (OR = 0.32; p = 0.02), and 24 months (OR = 0.30; p = 0.02) post-severe TBI. The relationship among these polymorphisms, protein levels, and biomarker utility, merits examination. These findings represent a novel contribution to the evidence that can inform future studies aimed at enhancing interpretation of biomarker data, identifying novel biomarkers, and ultimately harnessing this information to improve clinical outcomes and personalize care.

Initial blood pH as an independent predictor of neurological outcome in patients with out-of-hospital cardiac arrest

Initial blood pH as an independent predictor of neurological outcome in patients with out-of-hospital cardiac arrest

MRI for early prediction of outcome in preterm infants: Which items?

Objectives Early prediction of neurologic outcome of preterm infants is challenging. MRI provides interesting insights. Usual MRI interpretation looking for lesions (hemorrhage, cystic lesions, infarction, or “qualitative abnormalities”) has good predictive value for severe motor disabilities. Conversely those standard items are poor predictors of later, cognitive impairments. For this purpose, measuring volume of brain structures and cerebral growth is promising. In a prospective cohort study, we assessed global and regional cerebral growth, compared to outcome. Methods Infants born before 30 gestation weeks underwent serial MRI (between 25 and 28 weeks of gestation, then every three weeks until term). Cerebrum, cerebellum, brainstem, fluid spaces were estimated through twenty-five 2D measurements. Outcome was assessed with Bayley scale at two years of age. Results Hundred and eight preterm infants were included and 266 MRI performed. Main qualitative abnormalities were low-grade IVH (22%), severe IVH (6%), severe white matter injuries (21%), Cerebellar injuries (19%). Brain/Bone biparietal diameter, which has previously been strongly correlated with global cerebral volume, was significantly lower, as cerebellum and brainstem measurements. Impairment of regional brain growth is correlated with 2 years outcome. Conclusion We need to further search for correlation with later outcome at five and eight years. Brain MRI is a promising tool for early prognosis, but standard interpretation might include volume and cerebral growth assessments.

Serum lactate as a predictor of neurologic outcome in ED patients with acute carbon monoxide poisoning

BackgroundThis study was conducted to assess and clarify the predictive risk factor of neurologic outcome in patients with acute carbon monoxide (CO) poisoning. MethodsA total of 453 patients with acute CO poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2010 to June 2017. Patients with acute CO poisoning who were followed for >6 months were studied. Initial Glasgow Coma Score (GCS), serum neuron-specific enolase (NSE), and lactate were measured after emergency department arrival. Patients were divided into two groups (good vs poor neurologic outcome). ResultsA total of 432 patients (median age: 55 years, range: 17–91 years) were enrolled. There was a statistical difference between the good neurologic outcome group and the poor neurologic outcome group in terms of Exposure time, WBC, aspartate aminotransferase (AST), CK-MB, Troponin-I, creatinine kinase, NSE, lactate, CO-Hb, and GCS. NSE, lactate, and GCS were the early predictors of development of poor neurologic outcome. The areas under the curve in the ROC curve analysis for the GCS, NSE, and lactate were 0.842, 0.795, and 0.894, respectively. ConclusionInitial serum lactate level may correlate with the patient neurologic outcomes and prove to be a useful prognostic factor. Also NSE, and GCS might be a useful additional parameters that could predict the neurologic outcome on acute CO poisoned patients.

The impact of diastolic blood pressure values on the neurological outcome of cardiac arrest patients

AimWhich haemodynamic variable is the best predictor of neurological outcome remains unclear. We investigated the association of several haemodynamic variables with neurological outcome in CA patients. MethodsRetrospective analysis of adult comatose survivors of CA admitted to the intensive care unit (ICU) of a University Hospital. Exclusion criteria were early death due to withdrawal of care, missing haemodynamic data and use of intra-aortic balloon pump or extracorporeal membrane oxygenation. We retrieved CA characteristics; lactate concentration and cardiovascular sequential organ failure assessment (cSOFA) score on admission; systolic (SAP), diastolic (DAP), mean arterial pressure (MAP), and the use of vasopressors and inotropic agents during the first 6 h of ICU stay. Unfavourable neurological outcome (UO) was defined as a 3-month cerebral performance category score of 3–5. ResultsAmong the 170 patients (median age 63 years, 67% male, 60% out-of-hospital CA), 106 (63%) had UO. Admission lactate was higher in patients with UO than in those with favourable neurological outcome (4.0[2.4–7.3] vs. 2.5[1.4–6.0] mEq/L; p = 0.003) as was the cSOFA (3 [1–4] vs. 2[0–3]; p = 0.007). The lowest DAP during the first 6 h after ICU admission was significantly lower in patients with unfavourable neurological outcome, notably in patients with high cSOFA scores. In multivariable analysis, high adrenaline doses and the lowest value of DAP during the first 6 h after ICU admission was significantly associated with unfavourable neurological outcome. ConclusionsIn CA patients admitted to the ICU, low DAP during the first 6 h is an independent predictor of unfavourable neurological outcome at 3 months.

Molecular Biomarkers for Prediction of Neurological Outcome after Sudden Circulatory Arrest (Review)

The purpose of this review of the 81 publications is to discuss the current national and international data on the prediction of neurological outcomes after sudden circulatory arrest (SCA) using molecular biomarkers. The review discusses the current state of the problem of neurological outcomes after a sudden circulatory arrest, the principal therapeutic measures to improve these outcomes and currently available clinical, laboratory, and instrumental methods of diagnosis and prediction of neurological outcomes after a sudden circulatory arrest.

Heat Production After Cardiac Arrest: Predictor of Neurologic Outcome?*

Heat Production After Cardiac Arrest: Predictor of Neurologic Outcome?*

Imaging-based outcome prediction in patients with intracerebral hemorrhage.

Besides the established spot sign in computed tomography angiography (CTA), recently investigated imaging predictors of hematoma growth in noncontrast computed tomography (NCCT) suggest great potential for outcome prediction in patients with intracerebral hemorrhage (ICH). Secondary hematoma growth is an appealing target for therapeutic interventions because in contrast to other determined factors, it is potentially modifiable. Even more initial therapy studies failed to demonstrate clear therapeutic benefits, there is a need for an effective patient selection using imaging markers to identify patients at risk for poor outcome and thereby tailor individual treatments for every patient. Hence, this review gives an overview about the current literature on NCCT imaging markers for neurological outcome prediction and aims to clarify the association with the established spot sign. Moreover, it demonstrates the clinical impact of these parameters and gives a roadmap for future imaging research in patients with intracerebral hemorrhage.

Perinatal prediction model for severe intraventricular hemorrhage and the effect of early postnatal acidosis.

Severe acidosis is one of the strongest predictors of neurologic outcomes in full-term infants with suspected hypoxic-ischemic encephalopathy. However, the relative importance of acidosis as a predictor of outcomes in preterm infants is much less clear. The goals of the present study were to examine the association between postnatal acidosis and severe intraventricular hemorrhage (IVH) and to establish a new score model including acid-base status after birth for predicting the risk of this morbidity. The study sample was very low birth weight (VLBW) infants in the Korean Neonatal Network (KNN) cohort registry, collected prospectively from January 2013 to December 2014. Infants with blood pH and base deficit (BD) values collected within the first hour after birth, and documentation of severe IVH, were included. Multivariate stepwise logistic regression analysis was used to determine the contribution of postnatal acidosis to predicting severe IVH in VLBW infants. In addition, a prediction model was developed. Data from 2518 VLBW infants were analyzed. Infants with postnatal acidosis had a higher incidence of severe IVH. The clinical model plus blood BD values improved predictive performance, compared with models using only perinatal data or blood pH. A prediction model for severe IVH was developed using the KNN registry of VLBW infants. Immediate postnatal acidosis, defined based on blood BD, was associated with a higher-risk-adjusted incidence of severe IVH.

Natural History, Predictors of Outcome, and Effects of Treatment in Thoracic Spinal Cord Injury: A Multi-Center Cohort Study from the North American Clinical Trials Network

The course, treatment response, and recovery potential after acute traumatic spinal cord injury (SCI) have been shown to differ depending on the neurological level of injury. There are limited data focused on thoracic-level injuries, however. A cohort of 86 patients from the prospectively maintained North American Clinical Trials Network SCI registry were identified and studied to characterize the patterns of neurological recovery and to determine rates of acute hospital death and pulmonary complications. Regression analyses were used to examine the relationship between timing of surgery and administration of methylprednisolone on neurologic and clinical outcomes. Neurological conversion (≥1 American Spinal Injury Association Impairment Scale [AIS] grade improvement) was poorest for AIS grade A patients; 14.3% converted at last available follow-up (mean eight months). While rates of conversion were more optimistic for AIS-B patients (54.5%) and AIS C injuries (77.8%) at the same time point, none of the AIS grade D patients converted to AIS E. At last available follow-up (mean eight months), the magnitudes of lower motor extremity score (LEMS) change were highest for AIS C injuries (21.9 points), then AIS B (17.7 points), AIS D (16.4 points), and finally AIS A (2.5 points) (p < 0.05). Early surgical intervention (<24 h post-injury) was independently associated with an additional seven points in motor recovery and a 60% decreased incidence of pulmonary events (p < 0.05). Methylprednisolone administration was not an independent predictor of neurological outcome or pulmonary complications. Evaluation of this cohort obtained from a modern multi-center SCI registry provides an update on the natural history, acute death, and incidence of pulmonary complications after traumatic thoracic SCI. Although small sample size limited the extent of analyses possible, early surgical treatment was associated with significantly larger motor recovery and lower rates of pulmonary complications.

Encephaloduroarteriosynangiosis for pediatric moyamoya disease: long-term follow-up of 100 cases at a single center.

OBJECTIVE The object of this study was to summarize the long-term effect of encephaloduroarteriosynangiosis (EDAS) for the treatment of pediatric moyamoya disease (MMD) and to investigate factors influencing the clinical outcomes of EDAS. METHODS Clinical features, angiographic findings, and clinical outcomes were analyzed among MMD patients younger than 18 years who had been treated with EDAS between 2002 and 2007 at the authors' institution. The Kaplan-Meier method was used to estimate stroke risk after EDAS. Predictors of neurological outcome were assessed. RESULTS One hundred fifteen patients were identified. The mean age at symptom onset was 7.3 ± 4.0 years. The incidence of familial MMD was 11.3%. The female/male ratio was 1:1.16. A total of 232 EDAS procedures were performed, and the incidence of postoperative complications was 3%. Postoperative digital subtraction angiography was performed in 54% of the patients, and about 80% of the hemispheres showed good or excellent results. Neovascularization showed significant correlations with delay time (from symptom onset to first operation), Suzuki stage, and preoperative stroke (all p < 0.05). Clinical follow-up was available in 100 patients with a mean follow-up of 124.4 ± 10.5 months. Ten-year cumulative survival was 96.5% after surgery, and the risk of stroke was 0.33%/person-year. An independent life with no significant disability was reported by 92% of the patients. A good outcome correlated with a low Suzuki stage (p = 0.001). Older children and those without preoperative stroke had better clinical outcomes (p < 0.05). CONCLUSIONS On the basis of long-term follow-up data, the authors concluded that EDAS is a safe and effective treatment for pediatric MMD, can reduce the risk of subsequent neurological events, and can improve quality of life. The risk of ischemia-related complications was higher in younger patients, and older children showed better outcomes. Compensation was greater with more prominent cerebral ischemia. The long-term clinical outcome largely depended on the presence and extent of preoperative stroke.

F108. The prognostic value of median nerve SSEP after cardiac arrest: Evaluation of severity of hypoxic-ischemic encephalopathy by brain autopsies

Introduction The severity of hypoxic-ischemic encephalopathy (HIE) strongly determines outcome after cardiac arrest (CA). Bilaterally absent cortical median nerve somatosensory evoked potentials (SSEPs) have been shown to accurately predict poor prognosis. However, self-fulfilling prophecy due to withdrawal of life-sustaining therapy is an important bias in prognostication studies on CA patients. Brain autopsies in patients who died after CA provide a unique opportunity to verify prognostic parameters such as SSEPs. Methods We retrospectively identified CA patients from university hospitals in Berlin, Germany, Lund, Sweden and Arhus, Denmark, who died after initially successful resuscitation and for whom SSEPs for neuro-prognostication and brain autopsy were available. We blindly determined presence/absence and, if applicable, cortical peak-to-peak SSEP amplitudes from original recordings. Severity of HIE was quantified histopathologically according to the selective eosinophilic neuronal death (SEND) score. Results We identified 58 CA autopsy patients who had been investigated with SSEP. All 21 patients with bilaterally absent SSEP and all 5 with cortical SSEP amplitudes below 0.5 μV had severe HIE (SEND 2–4 in cortical regions). The highest cortical SSEP amplitude in a patient with severe HIE was 2.7 μV, all 11 patients with higher amplitudes had no/moderate HIE (SEND 0–1 in cortical regions). Conclusion We did not find evidence for a self-fulfilling prophecy in the prediction of poor neurological outcome by SSEP after cardiac arrest. Bilaterally absent cortical SSEP and very low SSEP amplitudes indicated histopathologically severe HIE whereas cortical SSEP amplitudes above 2.7 μV indicated absence of severe HIE.

T114. Predicting coma outcome using resting-state fMRI and machine learning

Introduction Early prediction of neurological outcome of post-anoxic comatose patients after cardiac arrest(CA) is challenging. Prognosis of comatose patient relies on multimodal testing: clinical examination, electrophysiological testing and structural neuroimaging (mainly diffusion MRI DWI). This multimodal prognostication is accurate for predicting poor outcome(i.e.death) but not sensitive for identifying patients with good outcome (i.e. consciousness recovery). Resting state functional MRI (rs-fMRI) is a powerful tool for mapping functional connectivity, especially in patients with low collaboration. Several studies showed that rs-fMRI can differentiate states of consciousness in chronically brain damaged patients. A recent study also showed that fMRI can detect early signs of consciousness in patient with acute traumatic brain injury. However, rs-fMRI has not been systematically assessed for the early prognositcation of post-anoxic comatose patient. Methods We assessed whole brain functional connectivity (FC) of 17 post-anoxic comatose patients early after CA using rs-fMRI. Nine patients recovered consciousness(good outcome) while eight died(poor outcome). We estimated FC for each patient following a standard procedure described by Leonardi and Richiardi et al. We statistically compared whole brain FC between good and poor outcome group, to assess which brain connections differed between them. Then, we trained a machine learning classifier(a Support Vector Machine classifier, SVM) using a Leave-One-Out Cross-Validation method, to automatically predict coma outcome (good/poor) based on whole-brain FC of comatose patients. Finally, we compared this outcome-prognostication based on fMRI to those using standard structural DWI. Results Good and poor coma outcome groups were similar in terms of demographics, except for time to ROSC. Good outcome group showed significant increase in whole-brain FC between most cortical brain regions, with the strongest changes occuring within and between occipital and parietal, temporal and frontal regions. Using whole-brain FC and a SVM classifier to predict coma outcome yielded to an overall prediction accuracy of 94.4% (AUC 0.94). Interestingly, automatic outcome prognostication using functional neuroimaging achieved better results that state-of the-art structural neuroimaging methods like DWI (accuracy 70.6%). Conclusion We used rs-fMRI to predict coma outcome in a cohort of post-anoxic comatose patients early after CA. We deliberately chose to include only patients with indeterminate prognosis after standard multimodal testing, in order to assess the contribution of rs-fMRI in the early prognostication of coma outcome. We found that automatic prediction based on fMRI yielded much better results than current diffusion neuroimaging methods, notably for identifying patients who recovered consciousness.

Combining early post-resuscitation EEG and HRV features improves the prognostic performance in cardiac arrest model of rats

ObjectiveEarly and reliable prediction of neurological outcome remains a challenge for comatose survivors of cardiac arrest (CA). The purpose of this study was to evaluate the predictive ability of EEG, heart rate variability (HRV) features and the combination of them for outcome prognostication in CA model of rats. MethodsForty-eight male Sprague-Dawley rats were randomized into 6 groups (n=8 each) with different cause and duration of untreated arrest. Cardiopulmonary resuscitation was initiated after 5, 6 and 7min of ventricular fibrillation or 4, 6 and 8min of asphyxia. EEG and ECG were continuously recorded for 4h under normothermia after resuscitation. The relationships between features of early post-resuscitation EEG, HRV and 96-hour outcome were investigated. Prognostic performances were evaluated using the area under receiver operating characteristic curve (AUC). ResultsAll of the animals were successfully resuscitated and 27 of them survived to 96h. Weighted-permutation entropy (WPE) and normalized high frequency (nHF) outperformed other EEG and HRV features for the prediction of survival. The AUC of WPE was markedly higher than that of nHF (0.892 vs. 0.759, p<0.001). The AUC was 0.954 when WPE and nHF were combined using a logistic regression model, which was significantly higher than the individual EEG (p=0.018) and HRV (p<0.001) features. ConclusionsEarlier post-resuscitation HRV provided prognostic information complementary to quantitative EEG in the CA model of rats. The combination of EEG and HRV features leads to improving performance of outcome prognostication compared to either EEG or HRV based features alone.

Value of neurophysiologic monitoring in confirming indirect decompression of severe pediatric non-traumatic C1–C2 subluxation. A case report

Abstract Spinal cord compression from severe C1–C2 subluxation is a complex and challenging neurosurgical problem. A combination of surgical approaches may be required to decompress the spinal cord, including anterior transoral odontoidectomy, posterior cervical laminectomy, or indirect decompression by subluxation reduction. After decompression, an instrumented posterior fusion is then required to stabilize the spine. We report a case of a 13-year-old-girl who presented with spastic quadriparesis secondary to severe atlantoaxial subluxation, where intraoperative neurophysiologic monitoring (IOM) guided surgical decision making. The patient had congenital osseous abnormalities, including incomplete segmentation of C2 on C3, predisposing her to atlantoaxial dislocation. She underwent open surgical reduction of the C1–C2 subluxation with multi-modal intraoperative neurophysiologic guidance. Translaminar C2 screws and C1 lateral mass screws were placed bilaterally. Using a previously described distraction technique, we performed ventral translation of C2 relative to C1, thereby reducing the subluxation. Intraoperative radiographic images and neurophysiologic monitoring revealed significant improvements, confirming that adequate indirect decompression had been achieved. After subluxation reduction with intraoperative monitoring (IOM) improvements, we decided to proceed with a C1–C2 posterior fusion and avoid a cervical laminectomy and more extensive occipital cervical fusion procedure. After one year, the girl made a complete neurologic recovery and remains symptom-free 3 years post-surgery. Fusion to the occiput would have potentially caused greater morbidity in this patient. The neurophysiologic monitoring confirmed indirect decompression and served as a critical tool for the prediction of favorable neurologic outcome.

Effect of surgical decompression of spinal metastases in acute treatment – Predictors of neurological outcome

ObjectiveSpace-occupying spinal metastases (SM), commonly diagnosed because of acute neurological deterioration, consequently lead to immediate decompression with tumor removal or debulking. In this study, we analyzed a series of patients with surgically treated spinal metastases and explicitly sought to determine individual predictors of functional outcome. Patients and methods94 patients (26 women, 68 men; mean age 64.0 years) with spinal metastases, who had been surgically treated at our department, were included retrospectively. We reviewed the pre- and postoperative charts, surgical reports, radiographic data for demographics, duration of symptoms, histopathology, stage of systemic disease, co-morbidities, radiographic extension, surgical strategy, neurological performance (Frankel Grade Classification), and the Karnofsky Performance Index (KPI). ResultsEmergency surgery within <24 h after discharge had been conducted in 33% of patients. Prostate carcinoma (29.5%) and breast carcinoma (11.6%) were the most common histopathologies. Median KPI was 60% at admission that had significantly improved at discharge (KPI 70%; p = 0.01). The rate of complications without revision was 4.3%, the revision rate 4.2%. From admission to discharge, pain had been significantly reduced (p = 0.019) and motor deficits significantly improved (p = 0.003). KPI had been significantly improved during in-hospital treatment (median 60 vs 70, p = 0.010). In the multivariable analysis, predictors of poor outcome (KPI < 70) were male sex, multiple metastases, and pre-existing bowel and bladder dysfunction. Median follow up was 2 months. DiscussionIn our series, surgery for spinal metastases (laminectomy, tumor removal, and mass reduction) significantly reduced pain as well as sensory and motor deficits. We identified male sex, multiple metastases, and pre-existing bowel and bladder dysfunction as predictors of negative outcome.

Predictors of Neurologic Outcomes After Extracorporeal Cardiopulmonary Resuscitation

Predictors of Neurologic Outcomes After Extracorporeal Cardiopulmonary Resuscitation

Magnetic Resonance Imaging to Predict Neurological Outcome in Children with Acute Encephalitis

Magnetic Resonance Imaging to Predict Neurological Outcome in Children with Acute Encephalitis

Brain Magnetic Resonance Imaging Findings of Congenital Cytomegalovirus Infection as a Prognostic Factor for Neurological Outcome

BackgroundThe aim of this study is to predict the neurological outcomes of patients with congenital cytomegalovirus infection by analysis of magnetic resonance images of the brain. MethodsFrom June 2007 to June 2016, 31 patients were diagnosed with symptomatic congenital cytomegalovirus infection at Asan Medical Center. The medical records and magnetic resonance imaging (MRI) findings of these patients were reviewed, and the relationships between MRI findings and neurological outcomes were analyzed. ResultsOf the 31 patients, 17 were male and 12 were born prematurely (gestation age less than 37 weeks). Twenty-one patients presented with delayed development, 11 with microcephaly, and 10 with sensorineural hearing loss. Eleven patients developed epilepsy. The most common abnormal findings on brain MRI were ventriculomegaly (N = 21, 67.7%) and polymicrogyria (N = 14, 45.2%). Delayed development significantly correlated with the presence of polymicrogyria (P = 0.001). Epilepsy was significantly associated with polymicrogyria (P = 0.012), ventriculomegaly (P = 0.045), calcification (P = 0.006), and white matter abnormalities (P = 0.018). Sensorineural hearing loss was not associated with any abnormal findings on brain MRI. Based on these data, a new brain magnetic resonance cytomegalovirus scoring scale was built and this scoring scale can predict the development of epilepsy with odds ratio 3.62 (confidence interval 1.52 to 8.67, P = 0.004). ConclusionsIn patients with congenital cytomegalovirus infections, brain MRI abnormalities could predict poor developmental outcomes and epilepsy, but not sensorineural hearing loss. Stratified magnetic resonance findings can be suggested as the predictors of neurological outcomes in individuals with congenital cytomegalovirus infections.

Cell free DNA: A Novel Predictor of Neurological Outcome after Intravenous Thrombolysis and/or Mechanical Thrombectomy in Acute Ischemic Stroke Patients.

PurposeSeveral blood markers have been evaluated in stroke patients, but their role remains limited in clinical practice. This study was designed to evaluate the utility of cell free DNA (cf DNA) in stroke patients undergoing therapeutic intervention in the form of mechanical thrombectomy in acute ischemic stroke patients.Materials and MethodsTwenty-six patients with ischemic stroke who were managed with interventions like intravenous thrombolysis (IVT) and mechanical thrombectomy were recruited consecutively in this study. The cf DNA was extracted by using circulating nucleic acid kit and measured by real-time quantitative PCR assay for β-globin gene. The neurological outcome was measured by modified Rankin scale (mRS) score at three months after the onset of symptoms.ResultsCf DNA levels correlated with severity of stroke at the time of admission (r=0.421, P=0.032) and poor outcome at three months (r=0.606, P=0.001). Therapeutic intervention in the form of mechanical thrombectomy or IVT was associated with improved outcome in patients with cf DNA <10,000 kilogenome-equivalents/L (P=<0.05).ConclusionCf DNA level correlated well with the 3 month outcome in acute ischemic stroke patients. It can be a potential supplementary marker to predict neurological outcome after therapeutic intervention.