Analysis Of Prognostic Factors Associated With Early Reperfusion Therapy In Acute Ischemic Stroke

Objective:To investigate the clinical prognosis of patients with acute ischemic stroke(AIS)treated with intravenous thrombolysis(IVT)and endovascular treatment(EVT)and the factors affecting the prognosis,and to provide a theoretical basis for optimizing the clinical treatment process.Methods:A total of 397 patients with AIS who met the inclusion criteria and received ultra-early treatment at The First Affiliated Hospital of Nanchang University Stroke Center from January 2020 to October 2021 were retrospectively included and divided into intravenous thrombolysis group and endovascular treatment group according to the treatment method.Their baseline data were collected separately,and the 90-day clinical prognosis was assessed by the modified Rankin Scale(m RS)score: the intravenous thrombolysis group was defined as good prognosis with m RS ≤ 2 and poor prognosis with m RS > 2 according to the conventional definition criteria;the endovascular treatment group added a subgroup defined as good prognosis with m RS≤ 4 and poor prognosis with m RS > 4 in addition to the conventional definition criteria grouping.The prognostic indicators were determined by single-factor and multi-factor logistic regression analysis between groups,and the receiver operator characteristic curves(ROC)were drawn to identify the indicators with the best predictive power for clinical prognosis.Results:Of the 397 patients included,225(56.7%)were in the intravenous thrombolysis group.There were 198 cases(88.8%)in the good prognosis group and 27 cases(12%)in the poor prognosis group.The results of univariate analysis showed that: the differences between the good prognosis group and the poor prognosis group in gender,age,smoking,alcohol consumption,fasting glucose,hyperlipidemia,neutrophilia,abnormal thyroid function,admission systolic blood pressure,pre-thrombolysis NIHSS score,post-thrombolysis NIHSS score,and hemorrhagic transformation were statistically significant(p < 0.05);the results of multi-factor logistic regression analysis showed that: pre-thrombolysis NIHSS score(OR = 1.174,95% CI1.047–1.315,p = 0.006)and hemorrhagic transformation(OR = 15.992,95% CI3.590–71.230,p < 0.001)were independent risk factors for poor 90 d prognosis;the results of plotting ROC curves showed that: pre-thrombolysis NIHSS score was a better predictor of poor 90 d poor prognosis was better predicted than bleeding conversion(AUC 0.766 vs 0.628)There were 172 cases(43.3%)in the endovascular treatment group.Conventionally defined subgroups: 80 cases(46.5%)in the good prognosis group and92 cases(53.5%)in the poor prognosis group.The results of univariate analysis showed that the differences between the good prognosis group and the poor prognosis group in gender,age,smoking,fasting glucose,abnormal thyroid function,baseline NIHSS score,postoperative m TICI classification,and hemorrhagic transformation were statistically significant(p < 0.05);the results of multi-factor logistic regression analysis showed that: age,fasting glucose,baseline NIHSS score,hemorrhagic transformation were positively correlated with poor prognosis,and postoperative m TICI classification was negatively correlated with poor prognosis.ROC curves showed that baseline NIHSS score was better than fasting glucose,hemorrhagic transformation,and age(AUC 0.761 vs 0.718 vs 0.691 vs 0.643),and postoperative m TICI grade had almost no predictive value(p = 0.151).Newly defined subgroups:108 cases(62.8%)in the good prognosis group and 64 cases(37.2%)in the poor prognosis group.The results of univariate analysis showed that the differences between the good prognosis group and the poor prognosis group in gender,age,smoking,fasting glucose,baseline NIHSS score,responsible vessel,postoperative m TICI grade,and hemorrhagic transformation were statistically significant(p <0.05);the results of multi-factor logistic regression analysis showed that: fasting glucose,baseline NIHSS score,and hemorrhagic transformation were positively correlated with poor prognosis,and postoperative m TICI classification was negatively correlated with poor prognosis.ROC curves showed that baseline NIHSS score was better than fasting glucose and hemorrhage conversion(AUC 0.774 vs0.691 vs 0.671),and postoperative m TICI grade had almost no predictive value(p =0.055).Conclusions:(1)Baseline NIHSS score and hemorrhagic transformation were independent risk factors for 90-day poor prognosis of IVT treatment in patients with AIS.(2)Fasting glucose,baseline NIHSS score,and hemorrhagic transformation were independent risk factors for 90-day poor prognosis after EVT.(3)Age and fasting glucose were influential factors for poor 90-day prognosis of early reperfusion therapy in patients with AIS,and baseline NIHSS score and hemorrhagic transformation were independent risk factors for poor 90-day prognosis of early reperfusion therapy in patients with AIS.