Clinical, biochemical and neuroimaging parameters after thrombolytic therapy predict long-term stroke outcome.
BACKGROUND
We investigated the predictive value of standard neurological evaluation, a commercially available biomarker assay and neuroimaging in the subacute phase for outcome after thrombolytic therapy in ischemic stroke.


METHODS
Thirty-four consecutive ischemic stroke patients were evaluated by means of the NIH Stroke Scale (NIHSS(72)), the Triage(R) Stroke Panel (MMX(72)) and standardized infarct volumetry at 72 h after treatment with intravenous recombinant tissue plasminogen activator or intra-arterial urokinase. Outcome was assessed by the modified Rankin Scale (mRS) at 3 months after the stroke.


RESULTS
NIHSS(72), MMX(72) and infarct volume correlated significantly with the mRS score at month 3 and emerged as independent outcome predictors from logistic regression analysis. NIHSS(72) is the best predictor for outcome, but its accuracy increases by 9 and 6% when combined with MMX(72) and infarct volumetry, respectively. The combined use of NIHSS(72) and MMX(72) allows long-term outcome prediction with 97% accuracy, which is not further improved by infarct volumetry.


CONCLUSIONS
Routine clinical evaluation, bedside testing of biochemical markers by the Triage Stroke Panel and infarct volumetry on neuroimaging at 72 h after thrombolytic therapy are predictors for long-term outcome of ischemic stroke patients. Clinical assessment is the most reliable parameter for outcome prediction, but its predictive value is substantially improved when combined with the biomarker panel.
Brouns
Raf
R
Department of Neurology and Memory Clinic, ZNA Middelheim Hospital, Antwerp, Belgium.
Sheorajpanday
Rishi
R
Kunnen
Jan
J
De Surgeloose
Didier
D
De Deyn
Peter Paul
PP
D000368:Aged; D015415:Biomarkers; D001921:Brain / Q000187:drug effects / Q000473:pathology; D002545:Brain Ischemia / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007118:Immunoassay; D016015:Logistic Models; D008297:Male; D009460:Neurologic Examination; D016017:Odds Ratio; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D015415:Biomarkers; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator