title: Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients.
abstract: 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.
authors.affiliation: Department of Neurology and National Core Research Center for Nanomedical Technology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.forename: Kyung-Yul
authors.initials: KY
authors.lastname: Lee
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
authors.forename: Seo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jong Yun
authors.initials: JY
authors.lastname: Lee
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Ahn
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: 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*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator