Background

Mechanical thrombectomy (MT) for large vessel occlusion (LVO) ischemic stroke is a safe and effective treatment modality. The National Institute of Health Stroke Scale (NIHSS) 24 h after MT (24 h-NIHSS) was shown to serve as the strongest surrogate for 90-day functional outcome. Here, we seek to externally validate 24 h-NIHSS as predictor for 90-day functional outcome and explore additional variables in this context.

Methods

Patients treated for anterior LVO between February 2016 and August 2020 with premorbid mRS < 3 were included. Receiver operating characteristics were used to compare different NIHSS-related surrogates, such as baseline (B) NIHSS, 24 h-NIHSS, Δ‑NIHSS and percent (%) change NIHSS to predict favorable function outcome (mRS 0–2). Additional analysis was performed to assess predictors associated with poor outcome despite reaching the best predictor threshold.

Results

A total of 337 eligible cases were identified. The 24 h-NIHSS outperformed B‑NIHSS, Δ‑NIHSS, and %‑NIHSS in terms of 90-day mRS 0–2 prediction. A 24-NIHSS ≤ 8 was identified as the optimal binary threshold. Multivariable analysis demonstrated that 24-NIHSS ≤ 8 and younger patient age were independently associated with mRS 0–2. Despite achieving 24 h-NIHSS ≤ 8, 23/143 (16.1%) cases experienced poor outcome (mRS 4–6). Older age, higher baseline NIHSS, coexisting chronic kidney disease, and longer hospital stay were independent predictors for poor outcome despite achieving 24 h-NIHSS ≤ 8.

Conclusion

An NIHSS of 8 or less 24 h after MT was validated to serve as an independent, strong surrogate for favorable functional outcome; however, cofactors such as older age, higher baseline NIHSS and coexisting comorbidities appear to mitigate this clinical adjunct.

中文翻译：

---

NIHSS 机械取栓后 24 小时预测 90 天功能结果

背景

大血管闭塞（LVO）缺血性卒中的机械血栓切除术（MT）是一种安全有效的治疗方式。MT 后 24 小时的美国国立卫生研究院卒中量表 (NIHSS) (24 h-NIHSS) 被证明可作为 90 天功能结果的最强替代指标。在这里，我们寻求外部验证 24 h-NIHSS 作为 90 天功能结果的预测因子，并在此背景下探索其他变量。

方法

纳入 2016 年 2 月至 2020 年 8 月期间接受前部 LVO 治疗且病前 mRS < 3 的患者。接受者操作特征用于比较不同的 NIHSS 相关替代指标，例如基线 (B) NIHSS、24 h-NIHSS、Δ-NIHSS 和 NIHSS 变化百分比 (%) 以预测有利的功能结果 (mRS 0-2)。尽管达到了最佳预测阈值，但进行了额外的分析以评估与不良结果相关的预测因子。

结果

共确定了337个符合条件的病例。在 90 天 mRS 0-2 预测方面，24 h-NIHSS 的表现优于 B‑NIHSS、Δ‑NIHSS 和 %‑NIHSS。24-NIHSS ≤ 8 被确定为最佳二元阈值。多变量分析表明，24-NIHSS ≤ 8 和更年轻的患者年龄与 mRS 0-2 独立相关。尽管实现了 24 h-NIHSS ≤ 8，但仍有 23/143 (16.1%) 例患者结局不佳 (mRS 4-6)。尽管 24 h-NIHSS ≤ 8，但年龄较大、基线 NIHSS 较高、合并慢性肾脏疾病和住院时间较长是不良预后的独立预测因素。

结论

验证 MT 后 24 小时 NIHSS 为 8 或更少，可作为良好功能结果的独立、强有力的替代指标；然而，诸如年龄较大、基线 NIHSS 较高和合并症等辅助因素似乎可以减轻这种临床辅助。