title: Clinical and MRI scale to predict very poor outcome in tissue plasminogen activator patients.
abstract: OBJECTIVE
  The present study aimed to devise a simple scale to predict very poor outcome after tissue plasminogen activator (t-PA) therapy using clinical and MRI factors.
  
  
  METHODS
  Consecutive stroke patients treated with t-PA within 3 h of onset were studied prospectively. Clinical factors and MRI findings independently associated with very poor outcome (modified Rankin Scale score 4-6) at 3 months after t-PA therapy were assessed.
  
  
  RESULTS
  The subjects were 117 patients. Multivariate logistic regression analysis revealed the following independent factors associated with very poor outcome: time from stroke onset to treatment ≥140 min (OR 2.790, 95% CI 1.082-7.193; p = 0.0337), baseline National Institutes of Health Stroke Scale score ≥20 (OR 3.794, 95% CI 1.199-12.009; p = 0.0233), glucose ≥180 mg/dl (OR 3.288, 95% CI 1.126-9.600; p = 0.0295), internal carotid artery occlusion (OR 6.187, 95% CI 5.090-18.354; p = 0.0129) and M1 susceptibility vessel sign (OR 6.379, 95% CI 1.194-34.074; p = 0.030). Those 5 variables were selected in the scale, with each factor as 1 point. Frequencies of patients with a very poor outcome for each score were as follows: score 0, 26.3%; score 1, 30.6%; score 2, 70.0%, and score 3-5, 100%.
  
  
  CONCLUSIONS
  A clinical scale using clinical and MRI factors can predict very poor outcome in t-PA patients.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. kimurak @ med.kawasaki-m.ac.jp
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator