Background

There is controversy regarding Alberta Stroke Program Early CT Score (ASPECTS) and platelet indices as predictors of outcome in patients with acute ischemic stroke (AIS). We aimed to assess the prognostic value of ASPECTS, mean platelet volume (MPV), plateletcrit (PCT), and platelet count (Plt) in 3-month and 1-year functional outcomes of AIS patients, both independently and in combination.

Methods

This prospective study was conducted in Shams Al-shomuos and Ghaem hospitals of Mashhad, Iran from June 2019 to January 2021. Overall, 553 patients above 18 years old with first-ever anterior circulation AIS met the eligibility criteria and were included. Clinical, hematologic, radiologic, and demographic data of patients were recorded at baseline. The 3-month and 1-year functional outcome was evaluated by modified Rankin Scale (mRS). Multivariate logistic regression was used to determine the independent predictors of poor functional outcome (mRS > 2) and mortality.

Results

The mean age of the patients was 65.50 ± 14.41 years and 282 patients (51%) were male. ASPECTS ≤ 7 was an independent predictor of both poor function (OR = 1.94, 95%CI = 1.04–3.62, P = 0.04) and mortality (OR = 2.02, 95%CI = 1.14–3.58, P = 0.02) at 1 year. MPV was also a strong predictor of 3-month (OR = 3.88, 95%CI = 2.04–7.38, P = 0.02) and 1-year (OR = 3.32, 95%CI = 1.91–5.78, P = 0.01) mortality, as well as 3-month (OR = 3.25, 95%CI = 1.80–5.86, P < 0.001) and 1-year (OR = 4.35, 95%CI = 2.36–8.02, P < 0.001) poor function.

For 1-year poor function (OR = 9.33, 95%CI = 2.19–39.73, P = 0.003) and mortality (OR = 6.40, 95%CI = 2.09–19.64, P = 0.001), ASPECTS combined with all platelet indices found to be a more robust independent predictor compared to each variable alone.

Conclusion

Although MPV is an independent predictor of both 3-month and 1-year poor function and mortality in AIS patients, ASPECTS ≤ 7 was found to be a risk factor for 1-year poor function and mortality. Moreover, the prognostic value of both platelet indices and ASPECTS are greater when they are combined together in AIS patients.

中文翻译：

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阿尔伯塔省卒中计划早期 CT 评分 (ASPECTS) 与平均血小板体积、血小板比容和血小板计数相结合预测急性缺血性卒中患者短期和长期预后的评估

背景

关于阿尔伯塔省卒中计划早期 CT 评分 (ASPECTS) 和血小板指数作为急性缺血性卒中 (AIS) 患者预后的预测因素存在争议。我们旨在评估 ASPECTS、平均血小板体积 (MPV)、血小板比容 (PCT) 和血小板计数 (Plt) 在 AIS 患者 3 个月和 1 年功能结果中的预后价值，包括独立和联合。

方法

这项前瞻性研究于 2019 年 6 月至 2021 年 1 月在伊朗马什哈德的 Shams Al-shomuos 和 Ghaem 医院进行。总体而言，553 名 18 岁以上的首次前循环 AIS 患者符合资格标准并被纳入研究。在基线时记录患者的临床、血液学、放射学和人口统计学数据。通过改良的 Rankin 量表 (mRS) 评估 3 个月和 1 年的功能结果。多变量逻辑回归用于确定不良功能结果（mRS  >  2）和死亡率的独立预测因子。

结果

患者的平均年龄为 65.50 ± 14.41 岁，其中 282 名患者 (51%) 为男性。 ASPECTS ≤ 7 是 1 年时功能不良（OR =  1.94, 95%CI  =  1.04–3.62, P = 0.04）和死亡率（OR  =  2.02, 95%CI  =  1.14–3.58, P = 0.02）的独立预测因子. MPV 也是 3 个月 (OR  =  3.88, 95%CI  =  2.04–7.38, P = 0.02) 和 1 年 (OR  =  3.32, 95%CI  =  1.91–5.78, P = 0.01) 死亡率的强预测因子，以及 3 个月 (OR  =  3.25, 95%CI  =  1.80–5.86, P < 0.001) 和 1 年 (OR  =  4.35, 95%CI  =  2.36–8.02, P < 0.001) 功能不佳。

对于 1 年功能不佳（OR  =  9.33, 95%CI  =  2.19–39.73, P = 0.003）和死亡率（OR  =  6.40, 95%CI  =  2.09–19.64, P = 0.001），ASPECTS 结合所有血小板指数与单独的每个变量相比，它是一个更强大的独立预测器。

结论

尽管 MPV 是 AIS 患者 3 个月和 1 年功能不良和死亡率的独立预测因子，但 ASPECTS ≤ 7 被发现是 1 年功能不良和死亡率的危险因素。此外，血小板指数和 ASPECTS 在 AIS 患者中的预后价值更大。