Correlation Between Total Imaging Load Score Of Cerebral Small Vessel Disease And Prognosis Of Patients With Acute Cerebral Infarction

Objective:To investigate the correlation between the total imaging load score of cerebral small vessel disease(CSVD)and the neurological outcome of patients with acute cerebral infarction(ACI)at 90 days after onset,and the incidence of 1-year end point in ACI patients with different groups of CSVD total imaging load score.Methods:180 patients with acute cerebral infarction were collected and the baseline data and clinical features were recorded.The total CSVD load score(0-4 points)was calculated according to the imaging data,the patients with ACI were divided into mild group(CSVD score 0-1)and moderate-severe group(CSVD score 2-4)according to the score.Neurologic outcomes at 90 days of follow-up were classified into the good-prognosis group(mRS ≤2 points)and the bad-prognosis group(mRS≥3 points)according to the modified Rankin Scale(mRS),to explore the correlation between the total imaging load score of CSVD and the prognosis of neurological function in patients with ACI at 90 days,and to explore the predictive value of the total imaging load score of CSVD in the prognosis of neurological function in patients with ACI by using ROC curve.In addition,according to TOAST(Trial of Org 10172in Acute Stroke Treatment,TOAST)classification of etiology of ACI,select patients with large-artery atherosclerosis(LAA)and small-artery occlusion lacunar(SAO),objective to investigate the effect of CSVD total imaging load score on the 90-day neurological outcome in patients with different TOAST classification.Patients were last followed up for 1-year end point events to explore the incidence of 1-year end point events in ACI patients with different subgroups of the CSVD imaging total load score.Results:1.86 cases(47.8%)were mild CSVD(0-1 score),94 cases(52.2%)were moderate or severe CSVD(2-4 score).There were significant differences in age,history of hypertension,whether blood pressure was lowered regularly,course of hypertension,homocysteine,serum creatinine,serum uric acid and glomerular filtration rate(GFR)(P<0.05),correlation with CSVD severity,after adjustment for confounders,age(OR=1.035,95%CI=1.000-1.070,P=0.048)and history of hypertension(OR=2.150,95%CI=1.038-4.450,P=0.039)were significantly associated with moderate and severe CSVD.2.There were 137 patients(76.1%)in the good prognostic group(mRS≤2 points)and 43 patients(23.9%)in the bad prognostic group(mRS≥3 points).Univariate analysis showed that age,admission systolic blood pressure,hs-CRP,TG,Hcy,lipoprotein a,days of hospitalization and NIHSS score were significantly higher in the poor prognosis group than in the good prognosis group(P<0.05).There were 72 patients(40.0%)with lacunae,91 patients(50.6%)with WMH,81 patients(45.0%)with CMB,68 patients(37.8%)with PVS in the study group.The CMB and CSVD total load scores of the poor prognosis group were higher than those of the good prognosis group,the difference was statistically significant(P<0.05),and correlated with the prognosis of neurological function in 90 days.Multivariate Logistic regression analysis,age(OR=1.056,95%CI=1.007-1.106,P=0.024),length of hospital stay(OR=1.186,95%CI=1.025-1.373,P=0.022),admission NIHSS score(OR=1.422,95%CI=1.189-1.700,P<0.001),CSVD total load score(OR=1.460,95%CI=1.101-1.935,P=0.008)were independent risk factors for poor neurological outcome at 90 days,the difference was significant(P<0.05).The sensitivity and specificity of the combination of age,length of stay,NIHSS score and CSVD were 87.6%and 79.1%respectively,the area under the curve was larger than age,length of stay,admission NIHSS score,and CSVD total imaging load score.3.There were 53 cases of LAA-type ACI and 66 cases of SAO-type ACI.The comparison of baseline data between the two groups showed that the mean age of patients with SAO-type ACI was higher than that of patients with LAA-type ACI,the difference was statistically significant(P=0.029).The glomerular filtration rate of LAA Group was significantly higher than that of SAO group(P=0.041).LAA-type ACI had more alcohol drinking history than SAO-type ACI(P=0.006).The results of multivariate Logistic regression analysis of 90-day neurological outcome in patients with LAA-type ACI and SAO-type ACI suggested that:The 90-day neurologic outcome of patients with ACI of SAO type was significantly influenced by the total imaging load of CSVD(P=0.022),and the 90-day neurologic outcome of patients with ACI of LAA type was also significantly affected by the total imaging load of CSVD(P=0.025).In patients with LAA-type ACI,the optimal threshold of CSVD total load score for predicting 90-day neurological outcome was 2.5 points(AUC=0.690,95%CI=0.533-0.847,P=0.024),with a sensitivity of 84.8%and a specificity of 52.6%.In patients with SAO-type ACI,the optimal threshold of CSVD total load score for predicting 90-day neurological outcome was 1.5 points(AUC=0.701,95%CI=0.554-0.847,P=0.010),with a sensitivity of 61.7%and a specificity of 70.0%.4.Patients were followed up for 1-year end-point outcomes,and 6 were ultimately lost to follow-up.Among them,18 cases(10.34%)had recurrent cerebral infarction,5 cases(2.9%)had cerebral hemorrhage,and 8 cases(4.6%)died of all causes.There were 8 cases(9.3%)of recurrent cerebral infarction,2 cases(2.3%)of cerebral hemorrhage and 3 cases(3.5%)of all-cause death in CSVD mild group,10 cases(10.6%)of recurrent cerebral infarction and 3 cases(3.2%)of cerebral hemorrhage in CSVD moderate-severe group,and 3 cases(3.2%)of all-cause death in CSVD moderate-severe group,all-cause mortality was 5 cases(5.3%).Conclusions:1.Age,history of hypertension are independent risk factors for severity CSVD.Older,the more the severity of the combined hypertension CSVD.2.Age,duration of hospitalization,NIHSS score and CSVD total load score were independent risk factors for poor prognosis of 90-day neurological function in patients with ACI,and they were valuable in predicting the prognosis of 90-day neurological function,but the combined forecast is more valuable.3.The total load score of CSVD was valuable in predicting the 90-day prognosis of the patients with ACI of SAO type and the patients with ACI of LAA type.4.Patients with high CSVD load were more likely to have recurrent cerebral infarction,cerebral hemorrhage and death.