Yili Du, Jack E Pohlmann, Stefanos Chatzidakis, Benjamin Brush, Leigh Ann Malinger, Rebecca A Stafford, Anna M Cervantes-Arslanian, Emelia J Benjamin, Emily J Gilmore, Josée Dupuis, David M Greer, Stelios M Smirnakis, Shariq Mohammed, Charlene J Ong
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引用次数: 0
Abstract
Objective: This study assesses whether longitudinal quantitative pupillometry predicts neurological deterioration after large middle cerebral artery (MCA) stroke and determines how early changes are detectable.
Methods: This prospective, single-center observational cohort study included patients with large MCA stroke admitted to Boston Medical Center's intensive care unit (2019-2024). Associations between time-to-neurologic deterioration and quantitative pupillometry, including Neurological Pupil Index (NPi), were assessed using Cox proportional hazards models with time-dependent covariates adjusted for age, sex, and Alberta Stroke Program Early CT Score. Models using dilation velocity were compared with partial likelihood ratio tests. Pupillometric changes over 2-h intervals in the 12 h preceding deterioration were analyzed with linear mixed-effects modeling and Tukey's test. Matched referents (age, sex, stroke side, follow-up duration) were used for comparison. Optimal thresholds were identified using the Youden Index.
Results: Among 71 patients (mean age 66.5 years; 59.2% women), 32 (45.1%) experienced deterioration. A 1-unit decrease in NPi was associated with a higher hazard of deterioration (hazard ratio 2.46; 95% confidence interval 1.68-3.61). Dilation velocity improved model performance compared to NPi alone. NPi was significantly lower at 0-2 h (3.81 vs. 4.38, p = 0.001) and 2-4 h (3.71 vs. 4.38, p < 0.001) before deterioration compared to 10-12 h prior. Optimal thresholds were 4.01 for NPi, 0.49 mm/s for dilation velocity, and -0.15 change in NPi over 12 h.
Interpretation: Quantitative pupillometry predicts neurological deterioration in MCA stroke, with declines detectable up to 12 h prior. Dilation velocity shows promise as a novel biomarker. ANN NEUROL 2025.
目的：本研究评估纵向定量瞳孔测量法是否能预测大脑大中动脉（MCA）中风后的神经功能恶化，并确定如何检测早期变化。方法：这项前瞻性、单中心观察队列研究纳入了2019-2024年波士顿医疗中心重症监护室收治的大MCA脑卒中患者。使用Cox比例风险模型评估定量瞳孔测量（包括神经学瞳孔指数（NPi））与神经功能恶化时间之间的关系，并对年龄、性别和阿尔伯塔卒中计划早期CT评分进行调整。采用扩张速度的模型采用部分似然比检验进行比较。采用线性混合效应模型和Tukey检验分析恶化前12 h每隔2 h的瞳孔变化。采用匹配的参照对象（年龄、性别、卒中侧、随访时间）进行比较。使用约登指数确定最佳阈值。结果：71例患者中，平均年龄66.5岁；59.2%女性)，32例（45.1%）出现恶化。NPi每降低1个单位，恶化的风险就会增加(风险比2.46；95%置信区间1.68-3.61)。与单独的NPi相比，膨胀速度提高了模型性能。NPi在0-2小时（3.81 vs. 4.38, p = 0.001）和2-4小时（3.71 vs. 4.38, p）显著降低。解释：定量瞳孔测量预测MCA卒中的神经功能恶化，可在12小时前检测到下降。扩张速度有望成为一种新的生物标志物。Ann neurol 2025。
期刊介绍：
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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