Baseline NIHSS score and D-dimer in early prediction of large vessel occlusion in patients with acute ischemic stroke
10.3760/cma.j.issn.1671-0282.2023.02.019
- VernacularTitle:NIHSS评分及D-二聚体早期预测缺血性脑卒中患者大血管闭塞的价值研究
- Author:
Gang ZHANG
1
;
Deliang HU
;
Shulan ZHOU
;
Lina MAO
;
Lili JIANG
;
Jinsong ZHANG
;
Xufeng CHEN
;
Gannan WANG
;
Lei JIANG
Author Information
1. 南京医科大学第一附属医院急诊科，南京 210029
- Keywords:
D-dimer;
NIHSS score;
ischemic stroke;
large vessel occlusion;
endovascular therapy;
thrombolytic therapy;
atrial fibrillation;
Receiver operating characteri
- From:
Chinese Journal of Emergency Medicine
2023;32(2):236-240
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.
