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Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis

Wu, Zimu ; Zeng, Minyan ; Li, Chao ; Qiu, Hongyan ; Feng, Haixia ; Xu, Xiaonan ; Zhang, Haoyang LU orcid and Wu, Jun (2019) In Postgraduate Medical Journal 95(1122). p.181-186
Abstract
Objectives

The National Institute of Health Stroke Scale (NIHSS) is a predictor for the prognosis of acute ischaemic stroke (AIS) and its prediction is time-dependent. We examined the performance of NIHSS at different timepoints in predicting functional outcome of patients with thrombolysed AIS.
Methods

This prospective study included 269 patients with AIS treated with recombinant tissue plasminogen activator (rt-PA). Unfavourable functional outcome was defined as modified Rankin Scale score 4–6 at 3 months after rt-PA treatment. Receiver operating characteristic curves were used to examine the predictive power of NIHSS score at admission and 2 hours/24 hours/7 days/10 days after rt-PA treatment. Youden’s index was... (More)
Objectives

The National Institute of Health Stroke Scale (NIHSS) is a predictor for the prognosis of acute ischaemic stroke (AIS) and its prediction is time-dependent. We examined the performance of NIHSS at different timepoints in predicting functional outcome of patients with thrombolysed AIS.
Methods

This prospective study included 269 patients with AIS treated with recombinant tissue plasminogen activator (rt-PA). Unfavourable functional outcome was defined as modified Rankin Scale score 4–6 at 3 months after rt-PA treatment. Receiver operating characteristic curves were used to examine the predictive power of NIHSS score at admission and 2 hours/24 hours/7 days/10 days after rt-PA treatment. Youden’s index was used to select the threshold of NIHSS score. Logistic regression was used to estimate the ORs of unfavourable functional outcome for patients with NIHSS score higher than the selected thresholds.
Results

The threshold of NIHSS score at admission was 12 (sensitivity: 0.51, specificity: 0.84) with an acceptable predictive power (area under curve [AUC] 0.74) for unfavourable functional outcome. The threshold changed to 5 at 24 hours after rt-PA treatment (sensitivity: 0.83, specificity: 0.65) and remained unchanged afterwards. The predictive power and sensitivity sequentially increased over time and peaked at 10 days after rt-PA treatment (AUC 0.92, sensitivity: 0.85, specificity: 0.80). NIHSS scores higher than the thresholds were associated with elevated risk of unfavourable functional outcome at all timepoints (all p<0.001).
Conclusions

NIHSS is time-dependent in predicting AIS prognosis with increasing predictive power over time. Since patients whose NIHSS score ≥ 12 are likely to have unfavourable functional outcome with rt-PA treatment only, mechanical thrombectomy should be largely taken into consideration for these patients. (Less)
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author
; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
in
Postgraduate Medical Journal
volume
95
issue
1122
pages
181 - 186
publisher
BMJ Publishing Group
external identifiers
  • scopus:85064207683
ISSN
1469-0756
DOI
10.1136/postgradmedj-2019-136398
language
English
LU publication?
no
id
86ed34de-61eb-4d7e-b51c-b8f962c97149
date added to LUP
2024-02-05 16:09:15
date last changed
2024-02-06 08:15:09
@article{86ed34de-61eb-4d7e-b51c-b8f962c97149,
  abstract     = {{Objectives<br/><br/>The National Institute of Health Stroke Scale (NIHSS) is a predictor for the prognosis of acute ischaemic stroke (AIS) and its prediction is time-dependent. We examined the performance of NIHSS at different timepoints in predicting functional outcome of patients with thrombolysed AIS.<br/>Methods<br/><br/>This prospective study included 269 patients with AIS treated with recombinant tissue plasminogen activator (rt-PA). Unfavourable functional outcome was defined as modified Rankin Scale score 4–6 at 3 months after rt-PA treatment. Receiver operating characteristic curves were used to examine the predictive power of NIHSS score at admission and 2 hours/24 hours/7 days/10 days after rt-PA treatment. Youden’s index was used to select the threshold of NIHSS score. Logistic regression was used to estimate the ORs of unfavourable functional outcome for patients with NIHSS score higher than the selected thresholds.<br/>Results<br/><br/>The threshold of NIHSS score at admission was 12 (sensitivity: 0.51, specificity: 0.84) with an acceptable predictive power (area under curve [AUC] 0.74) for unfavourable functional outcome. The threshold changed to 5 at 24 hours after rt-PA treatment (sensitivity: 0.83, specificity: 0.65) and remained unchanged afterwards. The predictive power and sensitivity sequentially increased over time and peaked at 10 days after rt-PA treatment (AUC 0.92, sensitivity: 0.85, specificity: 0.80). NIHSS scores higher than the thresholds were associated with elevated risk of unfavourable functional outcome at all timepoints (all p&lt;0.001).<br/>Conclusions<br/><br/>NIHSS is time-dependent in predicting AIS prognosis with increasing predictive power over time. Since patients whose NIHSS score ≥ 12 are likely to have unfavourable functional outcome with rt-PA treatment only, mechanical thrombectomy should be largely taken into consideration for these patients.}},
  author       = {{Wu, Zimu and Zeng, Minyan and Li, Chao and Qiu, Hongyan and Feng, Haixia and Xu, Xiaonan and Zhang, Haoyang and Wu, Jun}},
  issn         = {{1469-0756}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{1122}},
  pages        = {{181--186}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Postgraduate Medical Journal}},
  title        = {{Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis}},
  url          = {{http://dx.doi.org/10.1136/postgradmedj-2019-136398}},
  doi          = {{10.1136/postgradmedj-2019-136398}},
  volume       = {{95}},
  year         = {{2019}},
}