Analysis on prognostic factors of ischemic stroke caused by middle cerebral artery stenosis or occlusion

Abstract

Objective To screen related influencing factors for good prognosis of ischemic stroke caused by middle cerebral artery (MCA) stenosis or occlusion. Methods A total of 109 patients with ischemic stroke caused by MCA stenosis or occlusion were enrolled in this study. Their clinical data were recorded, such as sex, age, time from onset to MRI, history [stroke and/or transient ischemic attack (TIA), coronary heart disease, atrial fibrillation, smoking and drinking], systolic blood pressure (SBP), diastolic blood pressure (DBP), serum glucose, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), plasma homocysteine (Hcy), National Institutes of Health Stroke Scale (NIHSS) score on admission and discharge, modified Rankin Scale (mRS) at 3-month follow-up. MRI and three-dimensional time-of-flight (3D-TOF) MRA were performed to get MCA stenosis rate, FLAIR vascular hyperintensity (FVH) score, FVH-diffusion-weighted imaging (DWI) mismatching proportion, DWI-Alberta Stroke Program Early CT Score (ASPECTS). Univariate and multivariate forward Logistic regression analysis was used to screen related influencing factors for good prognosis. Receiver operating characteristic (ROC) curve was used to evaluate the accuracy and best threshold of FVH and DWI-ASPECTS scores predicting good prognosis. Results According to mRS score, patients were divided into good prognosis group ((mRS≤2, N = 24) and poor prognosis group (mRS > 2, N = 85). Logistic regression analysis showed that DBP (OR = 0.924, 95% CI: 0.869-0.983; P = 0.013), FVH score (OR = 2.008, 95% CI: 1.404-2.873; P = 0.000) and DWI-ASPECTS score (OR = 1.955, 95% CI: 1.336-2.862; P = 0.001) were independent influencing factors for good prognosis. ROC curve showed that area under the curve (AUC) of FVH score was 0.768 (95% CI: 0.656-0.880, P = 0.000), AUC of DWI-ASPECTS score was 0.721 (95%CI: 0.608-0.834, P = 0.001). The best threshold of FVH score was 4.50, sensitivity was 0.625, specificity was 0.824, Youden index was 0.449. The best threshold of DWI-ASPECTS score was 6.50, sensitivity was 0.750, specificity was 0.671, Youden index was 0.421. Conclusions For ischemic stroke caused by MCA stenosis or occlusion, the related prognostic factors include DBP, FVH score and DWI-ASPECTS score, whereas FVH score has higher accuracy. DOI:10.3969/j.issn.1672-6731.2018.04.003