Novel Computed Tomography Perfusion and Laboratory Indices as Predictors of Long-Term Outcome and Survival in Acute Ischemic Stroke.

IF 3 Q2 CLINICAL NEUROLOGY
Eray Halil, Kostadin Kostadinov, Nikoleta Traykova, Neli Atanasova, Kiril Atliev, Elizabet Dzhambazova, Penka Atanassova
{"title":"Novel Computed Tomography Perfusion and Laboratory Indices as Predictors of Long-Term Outcome and Survival in Acute Ischemic Stroke.","authors":"Eray Halil, Kostadin Kostadinov, Nikoleta Traykova, Neli Atanasova, Kiril Atliev, Elizabet Dzhambazova, Penka Atanassova","doi":"10.3390/neurolint17090136","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/objectives: </strong>Acute ischemic stroke is a leading cause of mortality and long-term disability globally, with limited reliable early predictors of functional outcomes and survival. This study aimed to assess the prognostic value of two novel predictors: the hypoperfusion intensity ratio calculated from mean transit time and time-to-drain maps (HIR-MTT-TTD), derived from computed tomography perfusion (CTP) imaging parameters, and the Inflammation-Coagulation Index (ICI), which integrates systemic inflammatory (C-reactive protein and white blood cell count) and hemostatic (D-dimer) markers.</p><p><strong>Methods: </strong>This prospective, single-center observational study included 60 patients with acute ischemic stroke treated with intravenous thrombolysis and underwent pre-treatment CTP imaging. HIR-MTT-TTD evaluated collateral status and perfusion deficit severity, while ICI integrated C-reactive protein (CRP), white blood cell (WBC) count, and D-dimer levels. Functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, and modified Rankin Scale (mRS) at 24 h, 3 months, and 1 year.</p><p><strong>Results: </strong>Of 60 patients, 53.3% achieved functional independence (mRS 0-2) at 1 year. Unadjusted Cox models showed HIR-MTT-TTD (HR = 6.25, 95% CI: 1.48-26.30, <i>p</i> = 0.013) and ICI (HR = 1.08, 95% CI: 1.00-1.17, <i>p</i> = 0.052) were associated with higher 12-month mortality, worse mRS, and lower Barthel scores. After adjustment for age, BMI, smoking status, and sex, these associations became non-significant (HIR-MTT-TTD: HR = 2.83, 95% CI: 0.37-21.37, <i>p</i> = 0.314; ICI: HR = 1.07, 95% CI: 0.96-1.19, <i>p</i> = 0.211). Receiver operating characteristic (ROC) analysis indicated moderate predictive value, with ICI (AUC = 0.756, 95% CI: 0.600-0.867) outperforming HIR-MTT-TTD (AUC = 0.67, 95% CI: 0.48-0.83) for mortality prediction.</p><p><strong>Conclusions: </strong>The study introduces promising prognostic tools for functional outcomes. Elevated HIR-MTT-TTD and ICI values were independently associated with greater initial stroke severity, poorer functional recovery, and increased 1-year mortality. These findings underscore the prognostic significance of hypoperfusion intensity and systemic thrombo-inflammation in acute ischemic stroke. Combining the use of the presented indices may enhance early risk stratification and guide individualized treatment strategies.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"17 9","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12472316/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/neurolint17090136","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background/objectives: Acute ischemic stroke is a leading cause of mortality and long-term disability globally, with limited reliable early predictors of functional outcomes and survival. This study aimed to assess the prognostic value of two novel predictors: the hypoperfusion intensity ratio calculated from mean transit time and time-to-drain maps (HIR-MTT-TTD), derived from computed tomography perfusion (CTP) imaging parameters, and the Inflammation-Coagulation Index (ICI), which integrates systemic inflammatory (C-reactive protein and white blood cell count) and hemostatic (D-dimer) markers.

Methods: This prospective, single-center observational study included 60 patients with acute ischemic stroke treated with intravenous thrombolysis and underwent pre-treatment CTP imaging. HIR-MTT-TTD evaluated collateral status and perfusion deficit severity, while ICI integrated C-reactive protein (CRP), white blood cell (WBC) count, and D-dimer levels. Functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, and modified Rankin Scale (mRS) at 24 h, 3 months, and 1 year.

Results: Of 60 patients, 53.3% achieved functional independence (mRS 0-2) at 1 year. Unadjusted Cox models showed HIR-MTT-TTD (HR = 6.25, 95% CI: 1.48-26.30, p = 0.013) and ICI (HR = 1.08, 95% CI: 1.00-1.17, p = 0.052) were associated with higher 12-month mortality, worse mRS, and lower Barthel scores. After adjustment for age, BMI, smoking status, and sex, these associations became non-significant (HIR-MTT-TTD: HR = 2.83, 95% CI: 0.37-21.37, p = 0.314; ICI: HR = 1.07, 95% CI: 0.96-1.19, p = 0.211). Receiver operating characteristic (ROC) analysis indicated moderate predictive value, with ICI (AUC = 0.756, 95% CI: 0.600-0.867) outperforming HIR-MTT-TTD (AUC = 0.67, 95% CI: 0.48-0.83) for mortality prediction.

Conclusions: The study introduces promising prognostic tools for functional outcomes. Elevated HIR-MTT-TTD and ICI values were independently associated with greater initial stroke severity, poorer functional recovery, and increased 1-year mortality. These findings underscore the prognostic significance of hypoperfusion intensity and systemic thrombo-inflammation in acute ischemic stroke. Combining the use of the presented indices may enhance early risk stratification and guide individualized treatment strategies.

新型计算机断层扫描灌注和实验室指标作为急性缺血性脑卒中长期预后和生存的预测指标。
背景/目的:急性缺血性脑卒中是全球范围内死亡和长期残疾的主要原因,功能结局和生存的可靠早期预测指标有限。本研究旨在评估两种新的预测指标的预后价值:由计算机断层扫描灌注(CTP)成像参数计算的平均传输时间和引流时间图(HIR-MTT-TTD)计算的低灌注强度比,以及炎症-凝血指数(ICI),该指数综合了全身炎症(c反应蛋白和白细胞计数)和止血(d -二聚体)标志物。方法:本前瞻性、单中心观察性研究纳入60例静脉溶栓治疗的急性缺血性脑卒中患者,并进行治疗前CTP成像。HIR-MTT-TTD评估侧枝状态和灌注缺陷严重程度,而ICI综合了c反应蛋白(CRP)、白细胞(WBC)计数和d -二聚体水平。采用美国国立卫生研究院卒中量表(NIHSS)、Barthel指数和改良Rankin量表(mRS)在24小时、3个月和1年对功能结局进行评估。结果:60例患者中,53.3%在1年时实现了功能独立(mRS 0-2)。未经调整的Cox模型显示,HIR-MTT-TTD (HR = 6.25, 95% CI: 1.48-26.30, p = 0.013)和ICI (HR = 1.08, 95% CI: 1.00-1.17, p = 0.052)与较高的12个月死亡率、较差的mRS和较低的Barthel评分相关。调整年龄、BMI、吸烟状况和性别后,这些相关性变得不显著(HIR-MTT-TTD: HR = 2.83, 95% CI: 0.37-21.37, p = 0.314; ICI: HR = 1.07, 95% CI: 0.96-1.19, p = 0.211)。受试者工作特征(ROC)分析显示,ICI (AUC = 0.756, 95% CI: 0.600 ~ 0.867)预测死亡率优于HIR-MTT-TTD (AUC = 0.67, 95% CI: 0.48 ~ 0.83)。结论:该研究为功能预后提供了有希望的预后工具。HIR-MTT-TTD和ICI值升高与初始卒中严重程度加重、功能恢复较差和1年死亡率增加独立相关。这些发现强调了低灌注强度和全身性血栓炎症在急性缺血性卒中中的预后意义。综合使用这些指标可以加强早期风险分层,指导个体化治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信