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Clinical and MRI scale to predict very poor outcome in tissue plasminogen activator patients
Kazumi Kimura1, Yuki Sakamoto, Yasuyuki Iguchi
1Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. kimurak @ med.kawasaki-m.ac.jp
Background And Purpose:
The present study aimed to devise a simple scale to predict very poor outcome after tissue plasminogen activator (t-PA) therapy using clinical and MRI factors.
Methods:
Consecutive stroke patients treated with t-PA within 3 h of onset were studied prospectively. Clinical factors and MRI findings independently associated with very poor outcome (modified Rankin Scale score 4-6) at 3 months after t-PA therapy were assessed.
Results:
The subjects were 117 patients. Multivariate logistic regression analysis revealed the following independent factors associated with very poor outcome: time from stroke onset to treatment ≥140 min (OR 2.790, 95% CI 1.082-7.193; p = 0.0337), baseline National Institutes of Health Stroke Scale score ≥20 (OR 3.794, 95% CI 1.199-12.009; p = 0.0233), glucose ≥180 mg/dl (OR 3.288, 95% CI 1.126-9.600; p = 0.0295), internal carotid artery occlusion (OR 6.187, 95% CI 5.090-18.354; p = 0.0129) and M1 susceptibility vessel sign (OR 6.379, 95% CI 1.194-34.074; p = 0.030). Those 5 variables were selected in the scale, with each factor as 1 point. Frequencies of patients with a very poor outcome for each score were as follows: score 0, 26.3%; score 1, 30.6%; score 2, 70.0%, and score 3-5, 100%.
Conclusion:
A clinical scale using clinical and MRI factors can predict very poor outcome in t-PA patients.
Insights
A new scale using clinical and MRI factors can predict poor outcomes in patients receiving tissue plasminogen activator (t-PA) therapy for stroke. This tool helps identify individuals at higher risk for adverse results after t-PA treatment.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Tissue plasminogen activator (t-PA) is a critical treatment for acute ischemic stroke.
- Predicting very poor outcomes after t-PA therapy is essential for patient management.
- Current prediction methods may not fully integrate clinical and imaging data.
Purpose of the Study:
- To develop a simple clinical scale for predicting very poor outcomes post-t-PA therapy.
- To identify key clinical and MRI factors associated with poor outcomes.
- To aid in risk stratification for stroke patients receiving t-PA.
Main Methods:
- Prospective study of 117 consecutive stroke patients treated with t-PA within 3 hours.
- Multivariate logistic regression analysis to identify independent predictors of very poor outcome (modified Rankin Scale 4-6 at 3 months).
- Factors assessed included time to treatment, NIH Stroke Scale, glucose levels, carotid artery occlusion, and M1 susceptibility vessel sign.
Main Results:
- Five independent factors predicted very poor outcome: delayed treatment (≥140 min), high NIH Stroke Scale score (≥20), elevated glucose (≥180 mg/dl), internal carotid artery occlusion, and M1 susceptibility vessel sign.
- A scale was created where each factor contributed 1 point.
- Outcome probabilities ranged from 26.3% for score 0 to 100% for scores 3-5.
Conclusions:
- A simple scale incorporating clinical and MRI data effectively predicts very poor outcomes in t-PA treated stroke patients.
- This scale can assist clinicians in identifying high-risk individuals.
- Further validation may refine its clinical utility in acute stroke management.
