Clinical characteristics of acute ischemic stroke patients with negative CT perfusion imaging and influencing factors for their prognoses / 中华神经医学杂志

ABSTRACT

Objective:To analyze the clinical characteristics of acute ischemic stroke (AIS) patients with negative cerebral CT perfusion (CTP) and influencing factors for their prognoses.Methods:A retrospective analysis was performed; 448 patients with AIS admitted to Department of Neurology, Sixth Affiliated Hospital of Nantong University from January 2020 to June 2021 were enrolled. CTP images of these patients were processed by RAPID software, and they were divided into CTP-negative group and CTP-positive group according to cerebral infarction core and ischemic penumbra volumes. The clinical data were compared between patients from CTP-negative group and CTP-positive group and between patients from CTP-negative and CTP-positive subgroups accepted thrombolytic therapy. According to the prognoses 3 months after discharge, CTP negative patients were divided into poor prognosis group and good prognosis group. Independent influencing factors for poor prognosis in negative CTP patients were analyzed by univariate and multivariate Logistic regressions.Results:(1) In these 448 patients, 154 (34.4%) were with negative CTP and 294 (65.6%) were with positive CTP; compared with the CTP-positive group, the CTP-negative group had significantly younger age, significantly higher percentage of patients with diabetes, significantly lower percentage of patients with atrial fibrillation, statistically higher baseline systolic blood pressure, and significantly lower baseline National Institutes of Health Stroke Scale (NIHSS) scores, early neurological deterioration (END) incidence, modified Rankin scale (mRS) scores 3 months after discharge, and proportion of patients with poor prognosis ( P<0.05); significant differences in distributions of responsible circulations for the lesions and etiological classification (TOAST) were noted between the 2 groups ( P<0.05). Of the 448 patients, 270 received thrombolytic therapy, including 101 CTP-negative patients and 169 CTP-positive patients; compared with the CTP-positive subgroup, the CTP-negative subgroup had significantly younger age, significantly lower percentage of patients with atrial fibrillation, statistically higher baseline systolic blood pressure, and significantly lower baseline NIHSS scores, END incidence, mRS scores 3 months after discharge, and proportion of patients with poor prognosis ( P<0.05). (2) Of the 154 CTP negative patients, 31 had poor prognosis and 123 had good prognosis. Univariate Logistic regression analysis showed that baseline blood glucose, fasting blood glucose, glycosylated hemoglobin (HbA1C), baseline NIHSS scores and fibrinogen were the influencing factors for prognoses of CTP negative patients, with significant differences ( P<0.05). Multivariate Logistic regression analysis found that NIHSS ( OR=0.827, 95% CI: 0.743-0.920, P<0.001) and HbA1 C ( OR=0.763, 95% CI: 0.609-0.956, P=0.019) were independent influencing factors for poor prognosis of CTP-negative patients. Conclusion:AIS patients with negative CTP have milder neurological impairment, better prognosis, and higher safety of receiving intravenous thrombolysis than those with positive CTP; AIS patients with negative CTP enjoying high baseline NIHSS scores and HBA1c have poor prognosis.