Zhixia Li, Jiheng Hao, Changming Wen, Tao Cheng, Yanxin Zhao, Xuesong Bai, Xiaofan Guo, Wenbo Cao, Tianhua Li, Xiao-Li Min, Liqun Jiao, Liyong Zhang, Bin Yang
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Data from 1242 patients were analysed for demographic, laboratory, imaging and perioperative data.</p><p><strong>Results: </strong>Among the 1242 recruited patients, 318 (25.60%) exhibited very poor outcomes. In multivariate analysis, predictors of very poor outcomes were higher age (OR 1.059, 95% CI 1.043 to 1.075, p<0.001), stroke history (OR 1.993, 95% CI 1.373 to 2.888, p<0.001), coronary heart disease history(CHD;OR=1.816,95% CI 1.291-2.552,P=0.001),higher baseline National Institute of Health Stroke Scale (NIHSS; OR 1.076, 95% CI 1.054 to 1.099, p<0.001), higher neutrophil count (OR 1.078, 95% CI 1.025 to 1.134, p=0.003), lower Alberta Stroke Program Early CT Score (ASPECTS; OR 0.901, 95% CI 0.845 to 0.962, p=0.002), higher malignant cerebral oedema (MCE, OR 3.246,95% CI 2.241 to 4.713, p<0.001) and symptomatic intracranial haemorrhage (sICH, OR 3.97, 95% CI 2.569 to 6.169, p<0.001) and receiving intravenous thrombolysis (IVT, OR = 0.600,95% CI 0.431-0.830, P =0.002) . 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引用次数: 0
摘要
目的：本研究旨在探讨大血管闭塞急性缺血性脑卒中患者血管内取栓成功后预后极差的预测因素。设计：多中心回顾性研究。环境：数据来源于中国五个城市的三级医疗机构。研究对象：本研究纳入1242例行血管内取栓术的前循环大血管闭塞患者，按90天改良Rankin量表（mRS）评分分为预后极差组（mRS 5-6）和非预后极差组（mRS 0-4）。主要结局指标：主要结局是非常差的结局。对1242例患者的人口学、实验室、影像学和围手术期数据进行分析。结果：1242例入组患者中，318例（25.60%）预后极差。在多因素分析中，极差预后的预测因子为较高的年龄（OR 1.059, 95% CI 1.043 ~ 1.075）。结论：极差预后与高龄、冠心病史、卒中史、高NIHSS评分、高中性粒细胞计数、低ASPECTS以及存在MCE和siich相关，而接受静脉溶栓是一个保护因素。这些不良的预后预测因素可能在告知临床决策方面发挥关键作用。试验注册号：ClinicalTrials.gov (NCT06290076)；pre-results。
Predictive factors for very poor outcomes after endovascular thrombectomy in anterior circulation large vessel occlusion: a multicentre retrospective study in China.
Objective: This study aims to investigate the predictors of very poor outcomes in patients with acute ischaemic stroke due to large vessel occlusion after successful endovascular thrombectomy.
Design: A multicentre, retrospective study.
Setting: Data were derived from tertiary care facilities in five cities of China.
Participants: This study included 1242 patients with anterior circulation large-vessel occlusion who underwent endovascular thrombectomy, and they were stratified by 90-day modified Rankin Scale (mRS) scores into a very poor outcome group (mRS 5-6) and a non-very poor outcome group (mRS 0-4).
Primary outcome measures: The primary outcome was very poor outcomes. Data from 1242 patients were analysed for demographic, laboratory, imaging and perioperative data.
Results: Among the 1242 recruited patients, 318 (25.60%) exhibited very poor outcomes. In multivariate analysis, predictors of very poor outcomes were higher age (OR 1.059, 95% CI 1.043 to 1.075, p<0.001), stroke history (OR 1.993, 95% CI 1.373 to 2.888, p<0.001), coronary heart disease history(CHD;OR=1.816,95% CI 1.291-2.552,P=0.001),higher baseline National Institute of Health Stroke Scale (NIHSS; OR 1.076, 95% CI 1.054 to 1.099, p<0.001), higher neutrophil count (OR 1.078, 95% CI 1.025 to 1.134, p=0.003), lower Alberta Stroke Program Early CT Score (ASPECTS; OR 0.901, 95% CI 0.845 to 0.962, p=0.002), higher malignant cerebral oedema (MCE, OR 3.246,95% CI 2.241 to 4.713, p<0.001) and symptomatic intracranial haemorrhage (sICH, OR 3.97, 95% CI 2.569 to 6.169, p<0.001) and receiving intravenous thrombolysis (IVT, OR = 0.600,95% CI 0.431-0.830, P =0.002) . The predictive model demonstrated a certain degree of accuracy (area under the curve 0.839, 95% CI 0.813 to 0.864).
Conclusions: The very poor outcomes were associated with advanced age, CHD history, stroke history, high NIHSS score, high neutrophil count, low ASPECTS and presence of MCE and sICH, while receiving intravenous thrombolysis was a protective factor. These poor outcome predictors might play a crucial role in informing clinical decision-making.
期刊介绍：
BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.
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