Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients.
BACKGROUND
We investigated a method for assessing early improvement and predictive factors of early and late outcomes in patients receiving thrombolytic therapy.


METHODS
A total of 160 consecutive patients who received thrombolytic therapy were included in the study. Using National Institutes of Health Stroke Scale (NIHSS) scores, percent improvement [(baseline NIHSS score-24-hour NIHSS score)/baseline NIHSS score x 100] was calculated and compared with delta (baseline NIHSS score-24-hour NIHSS score) and with major neurological improvement (MNI, NIHSS score of 0-1 or >or=8 point improvement at 24 h) by receiver operating characteristic (ROC) curve analysis. Finally, we investigated the independent predictors of improvement at 24 h after the thrombolytic therapy and of favorable 3-month outcome (modified Rankin scale score 0-2).


RESULTS
By pairwise comparison of ROC curves, percent improvement was stronger than delta (p=0.004) and MNI (p<0.001) in predicting long-term outcome. First day improvement (FDI), defined as greater than 20% improvement, was a strong predictor of favorable 3-month outcome (OR 12.55, 95% CI 5.41-29.10). Recanalization (OR 3.30, 95% CI 1.28-8.45), absence of carotid T occlusion (OR 0.09, 95% CI 0.02-0.42) and hemorrhagic transformation (OR 0.25, 95% CI 0.09-0.73) were independent predictors of FDI. Independent predictors of favorable 3-month outcome were FDI, current smoking, absence of carotid T occlusion and hemorrhagic transformation.


CONCLUSIONS
Percent improvement at 24 h after thrombolytic therapy is a useful surrogate marker for predicting the long-term outcome. Our findings highlight the importance of early stroke management.
Nam
Hyo Suk
HS
Department of Neurology and National Core Research Center for Nanomedical Technology, Yonsei University College of Medicine, Seoul, South Korea.
Lee
Kyung-Yul
KY
Han
Sang Won
SW
Kim
Seo Hyun
SH
Lee
Jong Yun
JY
Ahn
Seong Hwan
SH
Kim
Dong Joon
DJ
Kim
Dong Ik
DI
Nam
Chung Mo
CM
Heo
Ji Hoe
JH
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D002340:Carotid Artery Diseases / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012720:Severity of Illness Index; D012907:Smoking; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator