Clinical and MRI scale to predict very poor outcome in tissue plasminogen activator patients

Eur Neurol. 2011;65(5):291-5. doi: 10.1159/000327690. Epub 2011 Apr 21.

Abstract

Background and purpose: The present study aimed to devise a simple scale to predict very poor outcome after tissue plasminogen activator (t-PA) therapy using clinical and MRI factors.

Methods: Consecutive stroke patients treated with t-PA within 3 h of onset were studied prospectively. Clinical factors and MRI findings independently associated with very poor outcome (modified Rankin Scale score 4-6) at 3 months after t-PA therapy were assessed.

Results: The subjects were 117 patients. Multivariate logistic regression analysis revealed the following independent factors associated with very poor outcome: time from stroke onset to treatment ≥140 min (OR 2.790, 95% CI 1.082-7.193; p = 0.0337), baseline National Institutes of Health Stroke Scale score ≥20 (OR 3.794, 95% CI 1.199-12.009; p = 0.0233), glucose ≥180 mg/dl (OR 3.288, 95% CI 1.126-9.600; p = 0.0295), internal carotid artery occlusion (OR 6.187, 95% CI 5.090-18.354; p = 0.0129) and M1 susceptibility vessel sign (OR 6.379, 95% CI 1.194-34.074; p = 0.030). Those 5 variables were selected in the scale, with each factor as 1 point. Frequencies of patients with a very poor outcome for each score were as follows: score 0, 26.3%; score 1, 30.6%; score 2, 70.0%, and score 3-5, 100%.

Conclusion: A clinical scale using clinical and MRI factors can predict very poor outcome in t-PA patients.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Predictive Value of Tests
  • Retrospective Studies
  • Stroke / diagnosis*
  • Stroke / drug therapy*
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator