Predictors of early neurological deterioration in patients with acute ischemic stroke based on OCSP classification system / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the predictors of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) based on the Oxfordshire Community Stroke Project (OCSP) classification system.Methods:Patients with AIS admitted to the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from February 2018 to November 2020 were enrolled retrospectively. According to the OCSP criteria, the patients were classified into total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), and lacunar infarct (LACI). END was defined as the National Institutes of Health Stroke Scale (NIHSS) total score within 72 h after onset increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Multivariate logistic regression analysis was used to determine the independent risk factors for END in AIS patients with different OCSP types. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of each index for END in AIS patients with different OCSP types. Results:A total of 405 patients with AIS were enrolled. Their age was 68.84±12.27 years, and 250 were males (61.7%); 132 patients (32.6%) were in the TACI group, 108 (26.7%) were in the PACI group, 61 (15.1%) were in the POCI group, and 104 (25.7%) were in the LACI group. END occurred in 136 patients (33.6%). Multivariate logistic regression analysis showed that homocysteine (Hcy) (odds ratio [ OR] 1.065, 95% confidence interval [ CI] 1.012-1.212; P=0.015), baseline NIHSS score ( OR 1.209, 95% CI 1.095-1.335; P<0.001) and the time from onset to admission ( OR 1.663, 95% CI 1.282-2.082; P<0.001) were significantly and independently correlated with END in the TACI group. Hcy ( OR 1.137, 95% CI 1.040-1.244; P=0.005), fasting blood glucose ( OR 1.714, 95% CI 1.272-2.311; P<0.001), neutrophil to lymphocyte ratio (NLR) ( OR 1.370, 95% CI 1.016-1.848; P=0.039) and the time from onset to admission ( OR 1.266, 95% CI 1.056-1.519; P=0.011) were significantly and independently correlated with END in the PACI group. NLR ( OR 1.446, 95% CI 1.031-2.027; P=0.033) was significantly and independently correlated with END in the POCI group. Fasting blood glucose ( OR 1.301, 95% CI 1.006-1.683; P=0.045), NLR ( OR 1.393, 95% CI 1.025-1.894; P=0.034) and the time from onset to admission ( OR 1.171, 95% CI 1.008-1.361; P=0.039) were significantly and independently correlated with END in the LACI group. ROC curve analysis showed that the areas under the curve (AUC) of Hcy and baseline NIHSS score for predicting END in the TACI group were 0.617 (95% CI 0.521-0.713; P=0.021) and 0.784 (95% CI 0.706-0.862; P<0.001). The optimal cut-off values were 15.91 μmol/L and 19.5 points, respectively. The sensitivity and specificity were 63.7% and 85.2%, 62.0% and 86.9%, respectively. The AUC of Hcy, fasting blood glucose and NLR for predicting END in the PACI group were 0.672 (95% CI 0.548-0.797; P=0.005), 0.794 (95% CI 0.697-0.891; P<0.001) and 0.674 (95% CI 0.560-0.788; P=0.005), respectively. The optimal cut-off values were 15.2 μmol/L, 6.85 mmol/L, and 3.71, respectively. The sensitivity and specificity were 61.3% and 77.9%, 80.6% and 72.8%, 67.7% and 79.4%, respectively. The AUC of NLR for predicting END in the POCI group was 0.850 (95% CI 0.735-0.964; P<0.001). The optimal cut-off value was 5.2. The sensitivity and specificity were 84.2% and 81.4% respectively. The AUC of fasting blood glucose and NLR for predicting END in the LACI group were 0.728 (95% CI 0.614-0.842; P<0.001) and 0.731 (95% CI 0.614-0.842; P<0.001), respectively. The optimal cut-off values were 5.44 mmol/L and 2.71 respectively. The sensitivity and specificity were 80.0% and 62.7%, 76.0% and 79.2%, respectively. Conclusion:The predictors of END in AIS patients with different OCSP types are different.