A predictive model for functional outcomes in patients with acute anterior circulation stroke based on DWI-ASPECTS and serum homocysteine

IF 2.5 4区综合性期刊 Q2 MULTIDISCIPLINARY SCIENCES

Journal of Radiation Research and Applied Sciences Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI:10.1016/j.jrras.2026.102163

Meilin Wang , Jinsong Cheng

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引用次数: 0

Abstract

Background

Precise forecasting of functional outcomes is crucial for managing acute anterior circulation stroke (AACS). We sought to develop and validate a predictive model for functional outcomes by integrating the DWI-ASPECTS score and serum homocysteine levels.

Methods

We retrospectively examined information from consecutive AACS patients admitted between January 2022 and January 2025. The individuals were classified into favorable (modified Rankin Scale [mRS] ≤ 2) and unfavorable (mRS >2) outcomes groups depending on their 90-day mRS score. Upon admission, clinical parameters, including the National Institutes of Health Stroke Scale score, were assessed. Diffusion-weighted imaging was performed within 24 h to calculate the DWI-ASPECTS. Blood samples taken from a vein after an overnight fast were gathered within a 24-h timeframe for laboratory testing, including serum homocysteine, glycated hemoglobin, and lipid profiles.

Results

We included 122 patients, among whom 68 cases belonged to the favorable and 54 cases belonged to the unfavorable outcome group. Unfavorable outcome patients were significantly older (P = 0.017), exhibited higher baseline NIHSS scores, lower DWI-ASPECTS scores, and demonstrated elevated serum homocysteine levels (all P < 0.001). Multivariate analysis showed that DWI-ASPECTS score (OR = 0.270, P < 0.001) and serum homocysteine level (OR = 1.539, P < 0.001) independently predicted functional outcome. DWI-ASPECTS (AUC = 0.852) and homocysteine (AUC = 0.844) demonstrated high predictive accuracy. The final nomogram model, which combined these two variables, showed excellent discrimination with an AUC of 0.939 and was well-calibrated.

Conclusion

The developed nomogram, incorporating DWI-ASPECTS and serum homocysteine, demonstrates potential as an effective and accurate method for forecasting functional outcomes in AACS patients, offering a novel approach that integrates neuroanatomical and systemic metabolic information beyond models relying on single parameters.

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基于DWI-ASPECTS和血清同型半胱氨酸的急性前循环卒中患者功能结局预测模型

背景：准确预测功能预后对于急性前循环卒中（AACS）的治疗至关重要。我们试图通过整合DWI-ASPECTS评分和血清同型半胱氨酸水平来开发和验证功能预后的预测模型。方法回顾性分析2022年1月至2025年1月住院的连续AACS患者的信息。根据患者90天mRS评分，将患者分为mRS≤2和mRS≤2两组。入院时，评估临床参数，包括美国国立卫生研究院卒中量表评分。24h内进行弥散加权成像计算DWI-ASPECTS。禁食过夜后采集静脉血样，在24小时内进行实验室检测，包括血清同型半胱氨酸、糖化血红蛋白和脂质谱。结果纳入122例患者，其中良结局组68例，不良结局组54例。不良结局患者明显年龄较大（P = 0.017）， NIHSS基线评分较高，DWI-ASPECTS评分较低，血清同型半胱氨酸水平升高（P均为0.001）。多因素分析显示，DWI-ASPECTS评分（OR = 0.270, P < 0.001）和血清同型半胱氨酸水平（OR = 1.539, P < 0.001）独立预测功能结局。DWI-ASPECTS （AUC = 0.852）和同型半胱氨酸（AUC = 0.844）具有较高的预测准确性。结合这两个变量的最终nomogram model具有很好的判别性，AUC为0.939，且校正良好。结论开发的包含DWI-ASPECTS和血清同型半胱氨酸的nomogram预测AACS患者功能结局的方法，提供了一种结合神经解剖学和全身代谢信息的新方法，超越了依赖单一参数的模型。

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

Journal of Radiation Research and Applied Sciences MULTIDISCIPLINARY SCIENCES-

自引率

5.90%

发文量

130

审稿时长

16 weeks

期刊介绍： Journal of Radiation Research and Applied Sciences provides a high quality medium for the publication of substantial, original and scientific and technological papers on the development and applications of nuclear, radiation and isotopes in biology, medicine, drugs, biochemistry, microbiology, agriculture, entomology, food technology, chemistry, physics, solid states, engineering, environmental and applied sciences.