Risk factors and predictive value of early neurological deterioration in patients with minor stroke caused by middle cerebral artery occlusion / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the risk factors and predictive value of early neurological deterioration (END) in patients with minor stroke caused by middle cerebral artery occlusion.Methods:Consecutive patients with minor stroke caused by middle cerebral artery occlusion admitted to Zhangjiagang Hospital Affiliated to Soochow University from October 2021 to May 2023 were retrospectively included. Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5 at admission, and END was defined as an increase of ≥4 from baseline in the NIHSS score within 24 h of admission (excluding intracranial hemorrhage). Multivariate logistic regression analysis was used to determine independent risk factors for END. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of various risk factors on END. Results:A total of 130 patients with minor stroke caused by middle cerebral artery occlusion were included, of which 33 (25.4%) had END and 97 (74.6%) did not. Univariate analysis showed that there were statistically significant differences in NIHSS scores, volume with cerebral blood flow <30%, CT perfusion mismatch volume, baseline blood glucose, and baseline white blood cell count between the END and non-END groups (all P<0.05). Multivariate logistic regression analysis showed that CT perfusion mismatch volume (odds ratio [ OR] 1.010, 95% confidence interval [ CI] 1.003-1.017; P=0.007) and baseline white blood cell count ( OR 1.582, 95% CI 1.200-2.085; P=0.001) were the independent risk factors for END. ROC curve analysis showed that the area under the curves of CT perfusion mismatch volume and baseline white blood cell count for predicting END were 0.748 (95% CI 0.660-0.835; P<0.001) and 0.757 (95% CI 0.659-0.854; P<0.001), respectively. The area under the curve of combined predicting END was 0.821 (95% CI 0.738-0.905; P<0.001). Conclusions:CT perfusion mismatch volume and baseline white blood cell count are independent risk factors for the occurrence of END patients with minor stroke caused by middle cerebral artery occlusion, and the combination of the two has good predictive value for END.