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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Predicting Stroke Outcome Using Clinical-versus Imaging-based Scoring System
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Predicting Stroke Outcome Using Clinical-versus Imaging-based Scoring System

机译：使用基于临床对影像的评分系统预测中风预后

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Background: Several models to predict outcome in ischemic stroke patients receiving intravenous (i.v.) alteplase can be divided into clinical-based and imaging-based systems. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and Dense cerebral artery sign/early infarct signs on admission CT scan, prestroke modified Rankin Scale (mRS) score, Age, Glucose level at baseline, Onset-to-treatment time, and baseline National Institutes of Health Stroke Scale score (DRAGON) are typical imaging-and clinical-based scoring systems, respectively. Therefore, we compared predictability of stroke outcome of clinical (DRAGON)- and imaging (ASPECTS)- based scoring systems. Methods: We analyzed patients who were diagnosed with middle cerebral artery territory stroke and treated with i.v. alteplase at Gachon University Gil Hospital over 5 years and compared performance of 2 scoring systems for prediction of good functional outcome (mRS, 0-2) with Pearson correlation and area under the curve-receiver operating characteristic (AUC-ROC). In addition, we analyzed predicting power of several clinical factors and 2 scoring systems by multiple regression analysis. Results: Study population (N - 120) had mean age of 66.2 +/- 13.2 years. ASPECTS (r = -.841, P < .0001) and DRAGON (r = .657, P < .0001) were significantly correlated with good functional outcome. In addition, statistical comparisons suggested that ASPECTS (AUC-ROC,.972; 95% confidence interval [CI],.947-.996) is significantly superior to DRAGON (AUC-ROC,.854; 95% CI,.786-.922) in predicting functional outcome (difference between areas,.118 +/- .0332; 95% CI,.0559-.180, P = .0002). Multiple regression analysis revealed that ASPECTS was the independent predictor of good prognosis (OR, 6.59 per 1-point increase; 95% CI, 2.35-18.49; P < .0001 and OR, 77.67 for ASPECTS >= 8; 95% CI, 14.30-421.79; P < .0001). Conclusions: ASPECTS is superior method for predicting functional outcome in acute ischemic stroke patients receiving i.v. alteplase compared with DRAGON and integration of ASPECTS score into clinical care pathway as decision-making tool can be reasonable.
机译：背景：用于预测接受静脉（i.v.）阿替普酶治疗的缺血性中风患者预后的几种模型可以分为基于临床的系统和基于影像的系统。艾伯塔省卒中计划早期计算机断层扫描（CT）评分（ASPECTS）和入院CT扫描时脑密集动脉/早期梗死体征，卒中前改良兰金评分（mRS）评分，年龄，基线血糖水平，开始治疗的时间，美国国立卫生研究院卒中量表评分（DRAGON）和基线分别是典型的基于影像和临床的评分系统。因此，我们比较了基于临床（DRAGON）和影像（ASPECTS）的评分系统对卒中预后的可预测性。方法：我们分析了诊断为大脑中动脉区域性中风并接受静脉内治疗的患者。在Gachon大学Gil医院使用阿替普酶治疗了5年，并比较了两种评分系统的性能，这些结果用于预测良好的功能结局（mRS，0-2）与Pearson相关性和曲线接收器操作特征下的面积（AUC-ROC）。此外，我们通过多元回归分析分析了几种临床因素和2个评分系统的预测能力。结果：研究人群（N-120）的平均年龄为66.2 +/- 13.2岁。 ASPECTS（r = -.841，P <.0001）和DRAGON（r = .657，P <.0001）与良好的功能预后显着相关。此外，统计比较表明，ASPECTS（AUC-ROC，.972; 95％置信区间[CI] ,. 947-.996）显着优于DRAGON（AUC-ROC，.854; 95％CI，.786-预测功能结局（区域之间的差异，.118 +/- .0332; 95％CI，.0559-.180，P = .0002）。多元回归分析显示ASPECTS是良好预后的独立预测因子（OR，每增加1分6.59; 95％CI，2.35-18.49; P <.0001和OR，77.67（ASPECTS> = 8; 95％CI，14.30） -421.79; P <.0001）。结论：ASPECTS是预测接受静脉注射的急性缺血性中风患者功能预后的较好方法。阿替普酶与DRAGON的比较以及将ASPECTS评分纳入临床护理途径作为决策工具是合理的。

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