Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients

Hyo Suk Nam, Kyung Yul Lee, Sang Won Han, Seo Hyun Kim, Jong Yun Lee, Seong Hwan Ahn, Dong Joon Kim, Dong Ik Kim, Chung Mo Nam, Jihoe Heo

Research output: Contribution to journalArticle

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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 × 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 ≥ 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.

Original languageEnglish
Pages (from-to)69-73
Number of pages5
JournalJournal of the Neurological Sciences
Volume281
Issue number1-2
DOIs
Publication statusPublished - 2009 Jun 15

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National Institutes of Health (U.S.)
Stroke
Thrombolytic Therapy
Therapeutics
ROC Curve
Biomarkers
Smoking

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Nam, Hyo Suk ; Lee, Kyung Yul ; Han, Sang Won ; Kim, Seo Hyun ; Lee, Jong Yun ; Ahn, Seong Hwan ; Kim, Dong Joon ; Kim, Dong Ik ; Nam, Chung Mo ; Heo, Jihoe. / Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients. In: Journal of the Neurological Sciences. 2009 ; Vol. 281, No. 1-2. pp. 69-73.
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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 × 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 ≥ 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.",
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Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients. / Nam, Hyo Suk; Lee, Kyung Yul; Han, Sang Won; Kim, Seo Hyun; Lee, Jong Yun; Ahn, Seong Hwan; Kim, Dong Joon; Kim, Dong Ik; Nam, Chung Mo; Heo, Jihoe.

In: Journal of the Neurological Sciences, Vol. 281, No. 1-2, 15.06.2009, p. 69-73.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients

AU - Nam, Hyo Suk

AU - Lee, Kyung Yul

AU - Han, Sang Won

AU - Kim, Seo Hyun

AU - Lee, Jong Yun

AU - Ahn, Seong Hwan

AU - Kim, Dong Joon

AU - Kim, Dong Ik

AU - Nam, Chung Mo

AU - Heo, Jihoe

PY - 2009/6/15

Y1 - 2009/6/15

N2 - 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 × 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 ≥ 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.

AB - 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 × 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 ≥ 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.

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