| Objective:The present study was designed to compare the value of 6 commonly used risk scales in predicting the clinical prognosis after early endovascular treatment for anterior circulation large vessel occlusion stroke(ALVOS).Methods:Date of patients with ALVOS who received early endovascular treatment were consecutively collected in the first affiliated hospital of Suzhou University from July 2017 to April 2019.The following six scales were used:HAT(Hemorrhage After Thrombolysis),SEDAN [blood Sugar,Early infarct signs,(hyper)Dense cerebral artery sign,Age,National Institutes of Health Stroke Scale],SPAN(Stroke Prognostication using Age and National Institutes of Health Stroke Scale)-100,THRIVE(Total Health Risks In Vascular Events),GRASPS [Glucose at Presentation,Race(Asia),Age,Sex(male),systolic blood Pressure at presentation,and Severity of stroke at presentation(National Institutes of Health stroke Scale)] and MSS(Multicenter stroke Survey).The area under the receiver operating characteristic curve(AUROC)was calculated.Logistic regression and the HosmerLemeshow test were also performed.Result:1.General clinical characteristics of the study population68 patients with ALVOS who received early endovascular treatment were included in the study.The average age was 66 years(65.87±12.21years),and males were 39(57.3%),females were 29(42.7%).Among them,14(20.6%)patients received thrombolysis and endovascular treatment,54(79.4%)patients only treated with endovascular treatment.There was no significant difference in age,sex,baseline blood pressure,baseline blood glucose,past medical history,related laboratory examination,stroke severity(NIHSS score),collateral statu,recanalization statu,hemorrhagic transformation,pulmonary infection and prognosis between the two groups(P>0.05).2.Regression analysis and ROC analysis of different scales on poor prognosisAfter 3 months of follow up,33(48.5%)patients had a poor prognosis.The regression analysis showed that all the six scales were associated with poor prognosis(P < 0.05).Comparing the AUROC of the six scales,THRIVE scale had the highest AUROC for predicting poor prognosis,AUROC=0.784(95%CI 0.674～0.893),OR=0.512(95%CI 0.351～0.746),P=0.001.The best cutoff value of THRIVE scale was 3.5,that was,THRIVE score≥ 4,indicating a poor prognosis.The predictive value of 6 scales for poor prognosis between the two groups found the AUROC of THRIVE scale was the hightest(AUROC=0.958,P=0.005;AUROC=0.749,P=0.002)in two groups.SEDAN scale also had a good predictive value between the two groups(AUROC=0.885,P=0.045;AUROC=0.748,P=0.002).The predictive value of the scale for poor prognosis in the combined intravenous thrombolysis plus endovascular treatment group was higher than that in the direct endovascular treatment group.3.Regression analysis and ROC analysis of different scales on the hemorrhagic transformationDuring hospitalization,a total of 26 patients(38.2%)got any kind of HT.The regression analysis showed there was no significant correlation between SPAN-100 scale(OR=1.032,95%CI 0.994 ～ 1.072,P=0.099),MSS scale(OR=1.761,95%CI 0.983 ～3.156,P=0.057)in hemorrhagic transformation after treatment.Among the other four scales,THRIVE scale had the highest AUROC for predicting hemorrhagic transformation,AUROC=0.772(95%CI 0.663～0.881),OR=1.897(95%CI 1.309-2.749),P=0.001.The best cutoff value of THRIVE scale was 3.5,that was,THRIVE score≥ 4,indicating a high risk of hemorrhagic transformation.The predictive value of the six scales for hemorrhagic transformation in the two groups found THRIVE scale was the hightest(AUROC=0.885,P=0.017;AUROC=0.769,P=0.001).SEDAN scale also had a good predictive value between the two groups(AUROC=0.823,P=0.045;AUROC=0.714,P=0.011).The combined intravenous thrombolysis plus endovascular treatment group got a higher prediction than the other one.4.Regression analysis and ROC analysis of different scales on pulmonary infectionPulmonary infection occurred in 30 ALVOS patients(44.1%).The regression analysis showed that there was a significant correlation between the six scales and pulmonary infection after endovascular treatment.Among the the six scales,the AUROC of SEDAN scale was the highest,AUROC=0.800(95%CI 0.694～0.905),OR=3.700(95%CI 1.870～3.321),P < 0.001).The best cutoff value of SEDAN scale was 1.5,that was,SEDAN score≥ 2,indicating a high risk of pulmonary infection.SEDAN scale in the two groups also got the hightest score(AUROC=0.990,P=0.002;AUROC=0.729,P=0.004).Which scale also had a good predictive value in the two groups was THRIVE scale(AUROC=0.918,P=0.009;AUROC=0.717,P=0.007).The combined intravenous thrombolysis plus endovascular treatment group got a higher prediction than the other one.Conclusion:1.THRIVE scale had the highest predictive value for poor prognosis and hemorrhagic transformation.2.SEDAN scale had the highest predictive value for pulmonary infection.3.All the 6 scales were more suitable for patients treated by intravenous thrombolysis plus endovascular treatment. |
PDF Full Text Request