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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
ANGWC Nomogram for Predicting Poor 3-month Outcome after Intravenous Thrombolysis in Young and Middle-Aged Patients
Shuang-Yin Lei1, Yu-Qian Yang1, Yang Qu1
1Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China.
Insights
A new ANGWC nomogram helps predict poor outcomes after stroke treatment in younger adults. This tool identifies key risk factors, improving treatment decisions for ischemic stroke patients aged 18-59.
Area of Science:
- Neurology
- Cardiovascular Diseases
- Public Health
Background:
- Ischemic stroke is increasingly affecting younger populations, posing a significant health burden.
- Intravenous thrombolytic therapy offers benefits but outcomes in younger patients are less understood.
- Existing research often focuses on older stroke demographics, necessitating specific tools for younger adults.
Purpose of the Study:
- To identify risk factors for poor 3-month outcomes in young and middle-aged patients (18-59 years) receiving intravenous thrombolysis for their first ischemic stroke.
- To develop and validate a novel predictive nomogram for these outcomes.
Main Methods:
- A prospective study involving 217 patients in a training cohort and 113 in a validation cohort from multiple hospitals.
- Comparison of clinical data between favorable (modified Rankin Scale [mRS] < 2) and poor (mRS ≥ 2) outcome groups.
- Logistic regression analysis to develop the ANGWC nomogram (Age, NIHSS score, Glucose, White blood cell count, Cholesterol) and validation using AUC and Hosmer-Lemeshow tests.
Main Results:
- 47% of the training cohort experienced poor 3-month outcomes.
- The ANGWC nomogram, incorporating five variables, demonstrated good predictive performance with an AUC of 0.802 in the training set and 0.747 in the validation set.
- The nomogram showed good calibration and clinical utility, as confirmed by goodness-of-fit and decision curve analyses.
Conclusions:
- The ANGWC nomogram is a reliable tool for predicting poor 3-month outcomes in young and middle-aged patients undergoing intravenous thrombolysis for first-ever ischemic stroke.
- This predictive model can aid clinicians in risk stratification and personalized treatment strategies for this demographic.
- Further research may refine the nomogram and explore additional factors influencing stroke outcomes in younger individuals.
Background:
The rising prevalence of ischemic stroke among younger individuals is concerning. Despite the significant benefits of intravenous thrombolytic therapy for young and middle-aged patients, the disease burden in this demographic is often overshadowed by that of older patient groups. This study aims to identify the risk factors for poor 3-month outcomes following intravenous thrombolysis in young and middle-aged patients with first-ever stroke and to develop a novel nomogram.
Methods:
This prospective study included patients aged 18 to 59 years with a first ischemic stroke from 16 hospitals. Patients from one of the hospitals were designated as the training cohort. General information and clinical data were compared between the favorable outcome (modified Rankin Scale [mRS] score < 2) and the poor outcome groups (mRS score ≥ 2). Logistic regression analysis was used to develop the nomogram. An additional 113 patients from the other 15 hospitals were recruited as the validation cohort.
Results:
A total of 217 patients were enrolled in the training cohort, with 47% experiencing poor 3-month outcomes. Five variables were selected to construct the ANGWC (A: ge, N: IHSS score, blood G: lucose, W: hite blood cell count, and total C: holesterol) nomogram. The AUC of the nomogram was 0.802 in the training cohort and 0.747 in the validation cohort. The Hosmer-Lemeshow goodness-of-fit test showed a P-value > 0.05, and calibration curve slopes were close to 1. Decision curve analysis indicated good clinical utility.
Conclusion:
The ANGWC nomogram provides a reliable prediction of poor 3-month outcomes after intravenous thrombolysis in young and middle-aged patients with first-ever stroke.
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