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Performance of serial CT ASPECTS for predicting stroke outcomes in patients with thrombolyzed acute ischemic stroke
Sarawut Krongsut1, Wipasiri Naraphong2, Surachet Srikaew3
1Division of Neurology, Department of Internal Medicine, Saraburi Hospital, Saraburi, Thailand.
Insights
Serial ASPECTS, particularly at 24 hours and the change in ASPECTS, show improved accuracy in predicting intracranial hemorrhage (ICH) and poor outcomes in thrombolyzed acute ischemic stroke patients.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Acute ischemic stroke (AIS) treatment involves thrombolysis, but predicting outcomes is crucial.
- The Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic changes.
- Serial ASPECTS evaluations may offer enhanced predictive value over baseline assessments.
Purpose of the Study:
- To compare the predictive accuracy of serial ASPECTS (baseline, 24-h, and change) for intracranial hemorrhage (IHM) and unfavorable outcomes in thrombolyzed AIS patients.
- To determine if 24-hour or change in ASPECTS are superior to baseline ASPECTS.
- To evaluate modified Rankin Scale (mRS) scores at discharge as a measure of outcome.
Main Methods:
- Retrospective analysis of 345 thrombolyzed AIS patients from Saraburi Hospital (2015-2022).
- Receiver operating characteristic (ROC) curve analysis to compare the area under the curve (AuROC) for baseline, 24-h, and change in ASPECTS.
- Multivariable logistic regression used to adjust for potential confounders and report odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- 24-h ASPECTS (AuROC=0.955) and change in ASPECTS (AuROC=0.920) demonstrated higher predictive accuracy for IHM than baseline ASPECTS (AuROC=0.823).
- For unfavorable outcomes, 24-h ASPECTS (AuROC=0.853) and change in ASPECTS (AuROC=0.800) were also more accurate than baseline ASPECTS (AuROC=0.744).
- Adjusted ORs indicated that 24-h ASPECTS and change in ASPECTS significantly predicted both IHM and unfavorable outcomes.
Conclusions:
- 24-hour ASPECTS and the change in ASPECTS are more precise predictors of intracranial hemorrhage and unfavorable outcomes in thrombolyzed AIS patients.
- Serial ASPECTS assessments provide valuable prognostic information beyond baseline evaluation.
- These findings support the use of serial ASPECTS in managing thrombolyzed AIS patients.
Objectives:
The objective of this study was to compare the sensitivity and specificity of serial ASPECTS for predicting IHM and unfavorable outcome defined by a modified Rankin Scale score ≥3 at the time of discharge from the hospital in thrombolyzed AACIS patients.
Materials And Methods:
This retrospective study examined thrombolyzed AACIS patients admitted at Saraburi Hospital, a regional health-care facility in Thailand. The study was conducted between January 2015 and July 2022. The comparative predictive performance of the baseline ASPECTS, 24-h ASPECTS, and change in ASPECTS for IHM and unfavorable outcome was examined using the receiver operating characteristic (ROC) curves. The optimal cutoff values were identified based on Youden's index and the nonparametric method to compare the area under the ROC curve (AuROC) among the three scales. The potential confounders adjusted by multivariable logistic regression were reported odds ratio (OR) and 95% confidence interval (CI).
Results:
Three hundred and forty-five patients with thrombolyzed AACIS were analyzed; the median age was 61.8 ± 15.2 years. 53.0% were male, and the median National Institutes of Health Stroke Scale score was 11 points (interquartile range: 8-17). The AuROC for predicting IHM was 0.823 for the baseline ASPECTS, 0.955 for 24-h ASPECTS, and 0.920 for the change in ASPECTS. For predicting unfavorable outcome, the AuROC was 0.744 for the baseline ASPECTS, 0.853 for 24-h ASPECTS, and 0.800 for the change in ASPECTS. After adjusting for other factors, the OR for predicting IHM was 14.38 (95% CI: 1.69-122.57) for 24-h ASPECTS and 16.7 (95% CI: 4.36-64.01) for the change in ASPECTS. Regarding unfavorable outcome, the adjusted OR was 5.58 (95% CI: 1.83-17.01) for 24-h ASPECTS and 4.85 (95% CI: 2.45-9.60) for the change in ASPECTS.
Conclusion:
The 24-h ASPECTS and change in ASPECTS could be more precise predictors for predicting IHM and unfavorable outcome in patients with thrombolyzed AACIS.
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