| Objective Leukoaraiosis(LA)is the most common small vascular disease(CVSD)and is closely related to the increased risk of first or recurrent ischemic stroke,cerebral hemorrhage,and dementia.The ARWMC scale is highly recognized in the study of the effects of LA on cognition,and it is rarely used in the study of the functional prognosis of ischemic stroke.In this study,Fazekas scale,Van Swieten scale,and ARWMC scale were used to assess the severity of LA in patients with acute ischemic stroke(AIS),to explore the effect of LA on the functional prognosis of AIS patients and the application value of ARWMC scale in 30d and 90d functional prognosis of patients with AIS complicated with LA and the related risk factors affecting poor prognosis of AIS.Methods From October 2019 to August 2020,a total of 323 patients with acute ischemic stroke hospitalized in the Department of Neurology of the North Jiangsu People’s Hospital were enrolled continuously.The time from onset to admission is less than 24 hours for all patients.Clinical baseline data of these patients were collected,including gender,age,body mass index(BMI),hospitalization days,smoking history,alcoholism history,history of hypertension,history of type 2 diabetes,history of hyperlipidemia and history of coronary atherosclerotic heart disease.Laboratory test indicators after admission:hemoglobin,neutrophilic lymphocyte ratio(NLR),triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,D-D-polymer,etc.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological deficits of the patients.The modified Rankin Scale(MRS)was used to evaluate the functional outcomes of the patients at 30d and 90d.According to the cranial imaging data,the patients enrolled in AIS were divided into two groups without/with LA,and the clinical baseline data and functional prognosis of the two groups were compared.Cronbach’ α reliability analysis was used to analyze the reliability of Fazekas scale,Van Swieten scale and ARWMC scale(ARWMC scale was applicable to CT and MRI,and was recorded respectively as ARWMC-CT,ARWMC-MRI).The binary logistic regression modeling was used to analyze the impact of the severity of periventricular leukoaraiosis(PVH)and deep leukoaraiosis(DWMH)on the functional prognosis of patients;Receiver operator curve(ROC curve)was used to detect the predictive value of PVH and DWMH in AIS patients’ functional outcome.ROC curve was used to detect the predictive value of the Fazekas scale,Van Swieten scale,and ARWMC scale in predicting the functional outcome of patients with AIS at 30d and 90d.The Youden index analysis obtained the best ARWMC cut-off point for poor functional outcome and good functional outcome of AIS patients at 30d and 90d.According to the best cut-off point of ARWMC-MRI,patients were divided into two groups for univariate analysis,and the binary logistic regression model was used to analyze and compare the differences in clinical characteristics and functional prognosis between the two groups.The two groups with good functional prognosis and poor functional prognosis were subjected to univariate analysis,and the binary logistic regression model was used to analyze the risk factors affecting the poor functional outcome of AIS patients.Results 1.A total of 323 AIS patients meeting the criteria were enrolled,including 72 patients(22.3%)without LA and 251 patients(77.7%)with LA;advanced age was an independent risk factor for LA,P=0.000(95%CI 1.066-1.135,OR 1.100);200 cases(62.9%)in the 30d good prognosis group,123 cases(38.1%)in the poor prognosis group,15 cases(20.8%)in the non-LA group with poor function prognosis,and 15 cases(20.8%)in the LA group with poor function prognosis 108 cases(43.0%)(P=0.001);229 cases(70.9%)in the 90d good prognosis group,94 cases(29.1%)in the poor prognosis group,and 5 cases(6.9%)in the poor prognosis group without LA,with LA There were 89 patients(35.5%)with poor prognosis of moderate function(P=0.000).2.Among Fazekas scale,Van Swieten scale,ARWMC scale(ARWMC-MRI,ARWMC-CT)three scoring scales,ARWMC-MRI scale has the highest reliability(Cronbach’s α=0.892).3.PVH and DWMH are related to the 30d and 90d functional outcome of AIS patients;compared with PVH,DWMH is more closely related to poor functional outcome of AIS patients.The area under the ROC curve between PVH,DWMH and the patient’s 30d functional outcome are AUCPVH=0.656(95%CI PVH 0.594-0.718,P=0.000),AUCDWMH=0.671(95%CIDWMH 0.608-0.733,P=0.000);The area under the ROC curve between PVH and DWMH and the patient’s 90d functional outcome are AUCPVH=0.675(95%CIPVH 0.611-0.740,P=0.000),AUCDWMH=0.725(95%CIDWMH 0.622-0.788,P=0.000).4.The ROC curve of 30d functional outcome of AIS patients in ARWMC-MRI score was 0.719(95%CI 0.661-0.778,P=0.000),that of AIS patients in ARWMC-CT score was 0.718(95%CI 0.659-0.777,P=0.000),and that of AIS patients in Fazekas score was 0.702(95%CI 0.642-0.763,P=0.000).The ROC curve for functional outcome at 30d in Van Swieten score AIS patients was 0.707(95%CI 0.648-0.747,P=0.000).The ROC curve of 90d functional outcome of AIS patients in ARWMC-MRI score was 0.769(95%CI 0.714-0.824,P=0.000),that of functional outcome of AIS patients in ARWMC-CT score at 90d was 0.766(95%CI 0.709-0.822,P=0.000),and that of functional outcome of AIS patients in Fazekas score was AUC 0.753(95%CI 0.659-0.811,P=0.000).The ROC curve of functional outcome at 90 days in Van Swieten score at 90d was 0.745(95%CI 0.0.66-0.805,P=0.000).5.Using Youden index to analyze the ARWMC-MRI score,the best cut-off point for poor functional prognosis and good functional prognosis in AIS patients at 30 and 90 days is 15.5.Therefore,AIS patients are divided into A(ARWMC-MRI<15.5)and B(ARWMC-MRI≥15.5).In the two groups,the functional prognosis of patients in the two groups was significantly statistically significant at 30d and 90d(P30d=0.000,P90d=0.000).6.The binary logistic regression analysis showed that the 30d functional outcome-related risk factors including,advanced age P=0.038(OR 1.036 95%CI 1.002-1.071);admission NIHSS score P=0.000(OR 1.033 95%CI 1.332-1.149);ARWMC-MRI score P=0.000(OR 1.237 95%CI 1.067-1.168).Binary logistic regression analysis showed that the 90d functional outcome-related risk factors including,advanced age P=0.022(OR 1.039 95%CI 1.005-1.073);admission NIHSS score P=0.000(OR 1.237 95%CI 1.149-1.332);ARWMC-MRI score P=0.000(OR 1.117 95%CI 1.067-1.168).Conclusion LA increases the risk of poor functional outcome in AIS patients;advanced age is an independent risk factor for LA;moderate to severe DWMH is more closely related to poor functional outcome at 30 days and 90 days in AIS patients than PVH.The ARWMC-MRI score has the greatest predictive value in the 30d and 90d functional outcome of AIS patients,followed by the ARWMC-CT score,then the ARWMC scale may be an effective method to assess the functional outcome of AIS patients;Highly ARWMC-MRI score is a risk factor for poor functional prognosis in AIS patients at 30 and 90 days;ARWMC-MRI=15.5 is the best cutoff point for poor functional outcome and good functional outcome in AIS patients at 30 and 90 days and the functional outcome of AIS patients with ARWMC-MRI≥15.5 at 30 and 90 days is worse.Advanced age,high NIHSS score at admission,and high ARWMC-MRI score are independent risk factors for poor functional outcome of AIS patients at 30d and 90d. |
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