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Tanaka K, Brown S, Goyal M, Menon BK, Campbell BCV, Mitchell PJ, Jovin TG, Saver JL, Muir KW, White PM, Bracard S, Guillemin F, Roos YBWEM, van Zwam WH, Najm M, Dowlatshahi D, Hill MD, Demchuk AM. HERMES-24 Score Derivation and Validation for Simple and Robust Outcome Prediction After Large Vessel Occlusion Treatment. Stroke 2024; 55:1982-1990. [PMID: 39038101 DOI: 10.1161/strokeaha.123.045871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/04/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Clinicians need simple and highly predictive prognostic scores to assist practical decision-making. We aimed to develop a simple outcome prediction score applied 24 hours after anterior circulation acute ischemic stroke treatment with endovascular thrombectomy and validate it in patients treated both with and without endovascular thrombectomy. METHODS Using the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration data set (n=1764), patients in the endovascular thrombectomy arm were divided randomly into a derivation cohort (n=430) and a validation cohort (n=441). From a set of candidate predictors, logistic regression modeling using forward variable selection was used to select a model that was both parsimonious and highly predictive for modified Rankin Scale (mRS) ≤2 at 90 days. The score was validated in validation cohort, control arm (n=893), and external validation cohorts from the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke; n=1066) and INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography; n=614). RESULTS In the derivation cohort, we selected 2 significant predictors of mRS ≤2 (National Institutes of Health Stroke Scale score at 24 hours and age [β-coefficient, 0.34 and 0.06]) and derived the HERMES-24 score: age (years)/10+National Institutes of Health Stroke Scale score at 24 hours. The HERMES-24 score was highly predictive for mRS ≤2 (c-statistic 0.907 [95% CI, 0.879-0.935]) in the derivation cohort. In the validation cohort and the control arm, the HERMES-24 score predicts mRS ≤2 (c-statistic, 0.914 [95% CI, 0.886-0.944] and 0.909 [95% CI, 0.887-0.930]). Observed provability of mRS ≤2 ranged between 3.1% and 3.4% when HERMES-24 score ≥25, while it ranged between 90.6% and 93.0% when HERMES-24 score <10 in the derivation cohort, validation cohort, and control arm. The HERMES-24 score also showed c-statistics of 0.894 and 0.889 for mRS ≤2 in the ESCAPE-NA1 and INTERRSeCT populations. CONCLUSIONS The post-treatment HERMES-24 score is a simple validated score that predicts a 3-month outcome after anterior circulation large vessel occlusion stroke regardless of intervention, which helps prognostic discussion with families on day 2.
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Affiliation(s)
- Koji Tanaka
- Department of Clinical Neurosciences (K.T., M.G., B.K.M., M.N., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Scott Brown
- Altair Biostatistics, St. Louis Park, MN (S. Brown)
| | - Mayank Goyal
- Department of Clinical Neurosciences (K.T., M.G., B.K.M., M.N., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology and Hotchkiss Brain Institute (M.G., B.K.M., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences (K.T., M.G., B.K.M., M.N., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology and Hotchkiss Brain Institute (M.G., B.K.M., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (B.K.M., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre (B.C.V.C.), Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Peter J Mitchell
- Department of Radiology (P.J.M.), Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Tudor G Jovin
- Department of Neurology, Cooper University Health Care, Camden, NJ (T.G.J.)
| | - Jeffrey L Saver
- Department of Radiology and Neuroradiology, Universitätsklinikum Kiel, Schleswig-Holstein, Germany (J.L.S.)
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Phil M White
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, England, United Kingdom (P.M.W.)
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, Imagerie Adaptative Diagnostique et Interventionnelle (S. Bracard), Centre Hospitalier Régional Universitaire de Nancy, Institut national de la santé et de la recherche médicale, Université de Lorraine, France
| | - Francis Guillemin
- Clinical Epidemiology Center (F.G.), Centre Hospitalier Régional Universitaire de Nancy, Institut national de la santé et de la recherche médicale, Université de Lorraine, France
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Center, North Holland, the Netherlands (Y.B.W.E.M.R.)
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Rotterdam, South Holland, the Netherlands (W.H.v.Z.)
| | - Mohamed Najm
- Department of Clinical Neurosciences (K.T., M.G., B.K.M., M.N., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Dar Dowlatshahi
- Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D.)
| | - Michael D Hill
- Department of Clinical Neurosciences (K.T., M.G., B.K.M., M.N., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology and Hotchkiss Brain Institute (M.G., B.K.M., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (B.K.M., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Medicine (M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (K.T., M.G., B.K.M., M.N., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology and Hotchkiss Brain Institute (M.G., B.K.M., M.D.H., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
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Wang Q, Yin J, Xu L, Lu J, Chen J, Chen Y, Wufuer A, Gong T. Development and validation of outcome prediction model for reperfusion therapy in acute ischemic stroke using nomogram and machine learning. Neurol Sci 2024; 45:3255-3266. [PMID: 38277052 DOI: 10.1007/s10072-024-07329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To develop logistic regression nomogram and machine learning (ML)-based models to predict 3-month unfavorable functional outcome for acute ischemic stroke (AIS) patients undergoing reperfusion therapy. METHODS Patients undergoing reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) were prospectively recruited. Unfavorable outcome was defined as 3-month modified Rankin Scale (mRS) score 3-6. The independent risk factors associated with unfavorable outcome were obtained by regression analysis and included in the prediction model. The performance of nomogram was assessed by the area under the curve (AUC), calibration curve, and decision curve analysis (DCA). ML models were compared with nomogram using AUC; the generalizability of all models was ascertained in an external cohort. RESULTS A total of 505 patients were enrolled, with 256 in the model construction, and 249 in the external validation. Five variables were identified as prognostic factors: baseline NIHSS, D-dimer level, random blood glucose (RBG), blood urea nitrogen (BUN), and systolic blood pressure (SBP) before reperfusion. The AUC values of nomogram were 0.865, 0.818, and 0.779 in the training set, test set, and external validation, respectively. The calibration curve and DCA indicated appreciable reliability and good net benefits. The best three ML models were extra trees (ET), CatBoost, and random forest (RF) models; all of them showed favorable discrimination in the training cohort, and confirmed in the test and external sets. CONCLUSION Baseline NIHSS, D-dimer, RBG, BUN, and SBP before reperfusion were independent predictors for 3-month unfavorable outcome after reperfusion therapy in AIS patients. Both nomogram and ML models showed good discrimination and generalizability.
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Affiliation(s)
- Qianwen Wang
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100084, People's Republic of China
| | - Jiawen Yin
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Lei Xu
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yuhui Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
| | - Alimu Wufuer
- Department of Neurology, the First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, Xinjiang, People's Republic of China.
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100084, People's Republic of China.
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Li Y, Li N, Zhou Y, Li L. Predicting ineffective thrombolysis in acute ischemic stroke with clinical and biochemical markers. Sci Rep 2024; 14:13424. [PMID: 38862629 PMCID: PMC11166982 DOI: 10.1038/s41598-024-64413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/08/2024] [Indexed: 06/13/2024] Open
Abstract
**Ischemic stroke remains a leading cause of morbidity and mortality globally. Despite the advances in thrombolytic therapy, notably recombinant tissue plasminogen activator (rtPA), patient outcomes are highly variable. This study aims to introduce a novel predictive model, the Acute Stroke Thrombolysis Non-Responder Prediction Model (ASTN-RPM), to identify patients unlikely to benefit from rtPA within the critical early recovery window. We conducted a retrospective cohort study at Baoding No.1 Central Hospital including 709 adult patients diagnosed with acute ischemic stroke and treated with intravenous alteplase within the therapeutic time window. The ASTN-RPM was developed using Least Absolute Shrinkage and Selection Operator (LASSO) regression technique, incorporating a wide range of biomarkers and clinical parameters. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and Decision Curve Analysis (DCA). ASTN-RPM effectively identified patients at high risk of poor response to thrombolysis, with an AUC of 0.909 in the training set and 0.872 in the validation set, indicating high sensitivity and specificity. Key predictors included posterior circulation stroke, high admission NIHSS scores, extended door to needle time, and certain laboratory parameters like homocysteine levels. The ASTN-RPM stands as a potential tool for refining clinical decision-making in ischemic stroke management. By anticipating thrombolytic non-response, clinicians can personalize treatment strategies, possibly improving patient outcomes and reducing the burden of ineffective interventions. Future studies are needed for external validation and to explore the incorporation of emerging biomarkers and imaging data.
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Affiliation(s)
- Yinglei Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Emergency Medicine, Baoding No.1 Central Hospital, Baoding, China
| | - Ning Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuanyuan Zhou
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Litao Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China.
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China.
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Hebei General Hospital, Shijiazhuang, China.
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Shao H, Chan WCL, Du H, Chen XF, Ma Q, Shao Z. A new machine learning algorithm with high interpretability for improving the safety and efficiency of thrombolysis for stroke patients: A hospital-based pilot study. Digit Health 2023; 9:20552076221149528. [PMID: 36636727 PMCID: PMC9829886 DOI: 10.1177/20552076221149528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Thrombolysis is the first-line treatment for patients with acute ischemic stroke. Previous studies leveraged machine learning to assist neurologists in selecting patients who could benefit the most from thrombolysis. However, when designing the algorithm, most of the previous algorithms traded interpretability for predictive power, making the algorithms hard to be trusted by neurologists and be used in real clinical practice. Methods Our proposed algorithm is an advanced version of classical k-nearest neighbors classification algorithm (KNN). We achieved high interpretability by changing the isotropy in feature space of classical KNN. We leveraged a cohort of 189 patients to prove that our algorithm maintains the interpretability of previous models while in the meantime improving the predictive power when compared with the existing algorithms. The predictive powers of models were assessed by area under the receiver operating characteristic curve (AUC). Results In terms of interpretability, only onset time, diabetes, and baseline National Institutes of Health Stroke Scale (NIHSS) were statistically significant and their contributions to the final prediction were forced to be proportional to their feature importance values by the rescaling formula we defined. In terms of predictive power, our advanced KNN (AUC 0.88) outperformed the classical KNN (AUC 0.75, p = 0.0192 ). Conclusions Our preliminary results show that the advanced KNN achieved high AUC and identified consistent significant clinical features as previous clinical trials/observational studies did. This model shows the potential to assist in thrombolysis patient selection for improving the successful rate of thrombolysis.
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Affiliation(s)
- Huiling Shao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong,Huiling Shao, Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Room Y934, 9/F, Lee Shau Kee Building, Hung Hom, Kowloon, 999077, Hong Kong.
| | - Wing Chi Lawrence Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiangyan Fiona Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Qilin Ma
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhiyu Shao
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
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5
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Wu B, Liu F, Sun G, Wang S. Prognostic role of dynamic neutrophil-to-lymphocyte ratio in acute ischemic stroke after reperfusion therapy: A meta-analysis. Front Neurol 2023; 14:1118563. [PMID: 36873451 PMCID: PMC9978711 DOI: 10.3389/fneur.2023.1118563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Background The prognostic role of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, in acute ischemic stroke (AIS) after reperfusion therapy remains controversial. Therefore, this meta-analysis sought to assess the correlation between the dynamic NLR and the clinical outcomes of patients with AIS after reperfusion therapy. Methods PubMed, Web of Science, and Embase databases were searched to identify relevant literature from their inception to 27 October 2022. The clinical outcomes of interest included poor functional outcome (PFO) at 3 months, symptomatic intracerebral hemorrhage (sICH), and 3-month mortality. The NLR on admission (pre-treatment) and post-treatment was collected. The PFO was defined as a modified Rankin scale (mRS) of >2. Results A total of 17,232 patients in 52 studies were included in the meta-analysis. The admission NLR was higher in the 3-month PFO (standardized mean difference [SMD] = 0.46, 95% confidence interval [CI] = 0.35-0.57), sICH (SMD = 0.57, 95% CI = 0.30-0.85), and mortality at 3 months (SMD = 0.60, 95% CI = 0.34-0.87). An elevated admission NLR was associated with an increased risk of 3-month PFO (odds ratio [OR] = 1.13, 95% CI = 1.09-1.17), sICH (OR = 1.11, 95% CI = 1.06-1.16), and mortality at 3 months (OR = 1.13, 95% CI = 1.07-1.20). The post-treatment NLR was significantly higher in the 3-month PFO (SMD = 0.80, 95% CI = 0.62-0.99), sICH (SMD = 1.54, 95% CI = 0.97-2.10), and mortality at 3 months (SMD = 1.00, 95% CI = 0.31-1.69). An elevated post-treatment NLR was significantly associated with an increased risk of 3-month PFO (OR = 1.25, 95% CI = 1.16-1.35), sICH (OR = 1.14, 95% CI = 1.01-1.29), and mortality at 3 months (OR = 1.28, 95% CI = 1.09-1.50). Conclusion The admission and post-treatment NLR can be used as cost-effective and easily available biomarkers to predict the 3-month PFO, sICH, and mortality at 3 months in patients with AIS treated with reperfusion therapy. The post-treatment NLR provides better predictive power than the admission NLR. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022366394.
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Affiliation(s)
- Bing Wu
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
| | - Fang Liu
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
| | - Guiyan Sun
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
| | - Shuang Wang
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
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Shao H, Chen X, Ma Q, Shao Z, Du H, Chan LWC. The feasibility and accuracy of machine learning in improving safety and efficiency of thrombolysis for patients with stroke: Literature review and proposed improvements. Front Neurol 2022; 13:934929. [PMID: 36341121 PMCID: PMC9630915 DOI: 10.3389/fneur.2022.934929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
In the treatment of ischemic stroke, timely and efficient recanalization of occluded brain arteries can successfully salvage the ischemic brain. Thrombolysis is the first-line treatment for ischemic stroke. Machine learning models have the potential to select patients who could benefit the most from thrombolysis. In this study, we identified 29 related previous machine learning models, reviewed the models on the accuracy and feasibility, and proposed corresponding improvements. Regarding accuracy, lack of long-term outcome, treatment option consideration, and advanced radiological features were found in many previous studies in terms of model conceptualization. Regarding interpretability, most of the previous models chose restrictive models for high interpretability and did not mention processing time consideration. In the future, model conceptualization could be improved based on comprehensive neurological domain knowledge and feasibility needs to be achieved by elaborate computer science algorithms to increase the interpretability of flexible algorithms and shorten the processing time of the pipeline interpreting medical images.
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Affiliation(s)
- Huiling Shao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Qilin Ma
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhiyu Shao
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Lawrence Wing Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- *Correspondence: Lawrence Wing Chi Chan
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Ping Z, Min L, Qiuyun L, Xu C, Qingke B. Prognostic nomogram for the outcomes in acute stroke patients with intravenous thrombolysis. Front Neurosci 2022; 16:1017883. [PMID: 36340757 PMCID: PMC9627298 DOI: 10.3389/fnins.2022.1017883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background and purpose The prediction of neurological outcomes in ischemic stroke patients is very useful in treatment choices, as well as in post-stroke management. This study is to develop a convenient nomogram for the bedside evaluation of stroke patients with intravenous thrombolysis. Materials and methods We reviewed all enrolled stroke patients with intravenous thrombolysis retrospectively. Favorable outcome was defined as modified Rankin Score (mRs) less than 2 at 90 days post thrombolysis. We compared the clinical characteristics between patients with favorable outcome and poor outcome. Then, we applied logistic regression models and compared their predictability. Results A total of 918 patients were enrolled in this study, 448 patients from one hospital were included to develop a nomogram, whereas 470 patients from the other hospital were used for the external validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with baseline NIHSS, blood sugar, blood cholesterol level, part-and full anterior circulation infarction (OCSP type). The AUC was 0.767 (95% CI 0.653–0.772) and 0.836 (95% CI 0.697–0.847) in the derivation and external validation cohorts, respectively. The calibration plot for the probability of severe neurological outcome showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts. Conclusion A convenient outcome evaluation nomogram for patients with intravenous thrombolysis was developed, which could be used by physicians in making clinical decisions and predicting patients’ prognosis.
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Affiliation(s)
- Zheng Ping
- Key Laboratory and Neurosurgery, Shanghai Pudong New Area People’s Hospital, Shanghai, China
- *Correspondence: Zheng Ping, ; orcid.org/0000-0002-3928-3875
| | - Li Min
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Lu Qiuyun
- Department of Neurology, Shanghai Eighth People’s Hospital, Shanghai, China
| | - Chen Xu
- Department of Neurology, Shanghai Eighth People’s Hospital, Shanghai, China
| | - Bai Qingke
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, China
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Li S, Li J, Zhao Z, Xiao S, Shen X, Li X, Zu X, Li X, Shen Y. Delavatine A attenuates OGD/R-caused PC12 cell injury and apoptosis through suppressing the MKK7/JNK signaling pathway. Biol Pharm Bull 2022; 45:1743-1753. [PMID: 36130913 DOI: 10.1248/bpb.b22-00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Delavatine A (DA) is an unusual isoquinoline alkaloid with a novel skeleton isolated from Chinese folk medicine Incarvillea delavayi. Studies conducted in our lab have demonstrated that DA has potential anti-inflammatory activity in LPS-treated BV-2 cells. DA, however, has not been studied for its protective effect on neuronal cells yet. Thus, to explore whether DA can protect neurons, oxygen and glucose deprivation/reperfusion (OGD/R)-injured PC12 cell and middle cerebral artery occlusion/reperfusion (MCAO/R) rat model were used to assess the protective efficacy of DA against OGD/R damaged PC12 cells and MCAO/R injured rats. Our results demonstrated that DA pretreatment (0.31-2.5 μM) dose-dependently increased cell survival and mitochondrial membrane potential (MMP), whereas it lowered the leakage of lactate dehydrogenase (LDH), intracellular cumulation of Ca2+, and overproduction of reactive oxygen species (ROS), and inhibited the apoptosis rate in OGD/R-injured PC12 cells. Western blot demonstrated that DA pretreatment lowered the expression of apoptotic proteins and repressed the activation of the MKK7/JNK pathway. It was also found that the neuroprotective efficacy of DA was significantly reversed by co-treatment with the JNK agonist anisomycin, suggesting that DA reduced PC12 cell injury and apoptosis by suppressing the MKK7/JNK pathway. Furthermore, DA oral administration greatly alleviated the neurological dysfunction and reduced the infarct volume of MCAO/R rats. Taken together, DA could ameliorate OGD/R-caused PC12 cell injury and improve brain ischemia/reperfusion (I/R) damage in MCAO/R rats, and its neuroprotection might be attributed to suppressing the MKK7/JNK signaling pathway.
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Affiliation(s)
- Shanshan Li
- School of Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology of Natural Products, Kunming Medical University.,Department of Phytochemistry, School of Pharmacy, Naval Medical University
| | - Jiayu Li
- School of Pharmacy, Fujian University of Traditional Chinese Medicine
| | - Ziwei Zhao
- College of Nursing Health Sciences, Yunnan Open University
| | - Sijia Xiao
- Department of Phytochemistry, School of Pharmacy, Naval Medical University
| | - Xiuping Shen
- School of Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology of Natural Products, Kunming Medical University
| | - Xu Li
- School of Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology of Natural Products, Kunming Medical University
| | - Xianpeng Zu
- Department of Phytochemistry, School of Pharmacy, Naval Medical University
| | - Xian Li
- School of Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology of Natural Products, Kunming Medical University
| | - Yunheng Shen
- Department of Phytochemistry, School of Pharmacy, Naval Medical University
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Sharma D, Spring KJ, Bhaskar SMM. Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis. J Cent Nerv Syst Dis 2022; 14:11795735221092518. [PMID: 35492740 PMCID: PMC9052237 DOI: 10.1177/11795735221092518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Background Inflammation may mediate response to acute reperfusion therapy (RT) in acute
cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory
biomarker, may play an important role in acute ischaemic stroke (AIS)
prognostication. Objective This meta-analysis sought to examine the effect of NLR on functional
outcomes, mortality and adverse outcomes in AIS patients receiving RT. Methods Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane
databases. Data were extracted using a standardised data sheet and
meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR
with clinical/safety outcomes after RT was conducted. Results Thirty-five studies (n = 10 308) were identified for the systematic review
with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was
associated with good functional outcomes (GFOs), defined as 3-month modified
Rankin scale (mRS) 0–2 (SMD = −.46; 95% CI = −.62 to −.29; P < .0001),
mRS 0–1 (SMD = −.44; 95% CI = −.66 to −.22; P < .0001) and early
neurological improvement (ENI) (SMD = −.55; 95 %CI = −.84 to −.25; P <
.0001). Lower delayed admission NLR was also associated with GFOs (SMD =
−.80; 95%CI = −.91 to −.68; P < .0001). Higher admission NLR was
significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P =
.009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P =
.007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and
stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P
< .0001). Higher delayed NLR was significantly associated with sICH (SMD
= 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to
1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P <
.0001). There were variations in outcomes across RT groups. Conclusion Higher admission or delayed NLR is significantly associated with worse
morbidity, mortality and safety outcomes in AIS patients receiving RT.
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Affiliation(s)
- Divyansh Sharma
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kevin J. Spring
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Comprehensive Stroke Center, Sydney, NSW, Australia
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