Intravenous Thrombolysis in Acute Ischemic Stroke: A Prognostic Prediction Model and the Role of Ischemic Core Growth Rate

IF 5 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-09-04 DOI:10.1111/cns.70589

Yipeng Yu, Lulu Zhang, Qi Fang

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Abstract

Aims

The tissue window is increasingly recognized in guiding reperfusion therapy beyond the standard time window in acute ischemic stroke (AIS). This study aims to develop a nomogram incorporating an ischemic core growth rate index to provide individualized prediction of neurological outcomes in AIS patients who received intravenous thrombolysis (IVT).

Methods

A retrospective study was conducted at the First Affiliated Hospital of Soochow University (2016–2023). A lasso-logistic method was employed for variable selection and model construction. The performance of the model was evaluated using the receiver operating characteristic curve, calibration curve, decision curve analysis, and compared with a conventional indexed one.

Results

The study cohort comprised 553 patients with favorable outcomes (median ischemic core growth rate: 1.4 [0.5, 4.1] mL/h) and 198 patients with poor outcomes (median ischemic core growth rate: 5.7 [1.1, 14.2] mL/h). The nomogram included diabetes, TOAST classification, ischemic core growth rate, neutrophil count, direct bilirubin, and NIHSS score at admission. It achieved an AUC of 0.882 (95% CI: 0.855–0.908), outperforming the conventional indexed one. Calibration showed good agreement between predicted and observed outcomes (Hosmer–Lemeshow p = 0.851).

Conclusion

Ischemic core growth rate strongly correlates with neurological prognosis in AIS. This nomogram offers reliable predictions for IVT outcomes.

Abstract Image

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静脉溶栓治疗急性缺血性脑卒中：一种预后预测模型及缺血性脑核生长速率的作用

目的组织窗在指导急性缺血性脑卒中（AIS）标准时间窗之外的再灌注治疗中越来越受到重视。本研究旨在建立一种包含缺血核心生长速率指数的nomogram，为接受静脉溶栓（IVT）治疗的AIS患者的神经预后提供个性化预测。方法对2016-2023年在苏州大学第一附属医院进行回顾性研究。采用套索逻辑方法进行变量选择和模型构建。利用接收机工作特性曲线、标定曲线、决策曲线分析对模型的性能进行了评价，并与传统的指数化模型进行了比较。结果研究队列包括553例预后良好患者（中位缺血核心生长速率：1.4 [0.5,4.1]mL/h）和198例预后不良患者（中位缺血核心生长速率：5.7 [1.1,14.2]mL/h）。nomogram包括糖尿病、TOAST分类、缺血核心生长率、中性粒细胞计数、直接胆红素和入院时NIHSS评分。该方法的AUC为0.882 (95% CI: 0.855-0.908)，优于传统的指数化方法。校正显示预测结果与观察结果吻合良好（Hosmer-Lemeshow p = 0.851）。结论缺血性脑核生长速度与AIS患者神经系统预后密切相关。该nomogram为IVT结果提供了可靠的预测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.