Performance of serial CT ASPECTS for predicting stroke outcomes in patients with thrombolyzed acute ischemic stroke

Abstract

Objectives: The objective of this study was to compare the sensitivity and specificity of serial ASPECTS for predicting IHM and unfavorable outcome defined by a modified Rankin Scale score ≥3 at the time of discharge from the hospital in thrombolyzed AACIS patients.

Materials and methods: This retrospective study examined thrombolyzed AACIS patients admitted at Saraburi Hospital, a regional health-care facility in Thailand. The study was conducted between January 2015 and July 2022. The comparative predictive performance of the baseline ASPECTS, 24-h ASPECTS, and change in ASPECTS for IHM and unfavorable outcome was examined using the receiver operating characteristic (ROC) curves. The optimal cutoff values were identified based on Youden's index and the nonparametric method to compare the area under the ROC curve (AuROC) among the three scales. The potential confounders adjusted by multivariable logistic regression were reported odds ratio (OR) and 95% confidence interval (CI).

Results: Three hundred and forty-five patients with thrombolyzed AACIS were analyzed; the median age was 61.8 ± 15.2 years. 53.0% were male, and the median National Institutes of Health Stroke Scale score was 11 points (interquartile range: 8-17). The AuROC for predicting IHM was 0.823 for the baseline ASPECTS, 0.955 for 24-h ASPECTS, and 0.920 for the change in ASPECTS. For predicting unfavorable outcome, the AuROC was 0.744 for the baseline ASPECTS, 0.853 for 24-h ASPECTS, and 0.800 for the change in ASPECTS. After adjusting for other factors, the OR for predicting IHM was 14.38 (95% CI: 1.69-122.57) for 24-h ASPECTS and 16.7 (95% CI: 4.36-64.01) for the change in ASPECTS. Regarding unfavorable outcome, the adjusted OR was 5.58 (95% CI: 1.83-17.01) for 24-h ASPECTS and 4.85 (95% CI: 2.45-9.60) for the change in ASPECTS.

Conclusion: The 24-h ASPECTS and change in ASPECTS could be more precise predictors for predicting IHM and unfavorable outcome in patients with thrombolyzed AACIS.

Keywords: Alberta Stroke Program Early Computed Tomography Score; Mortality; Predictive accuracy; Thrombolyzed acute anterior circulation ischemic stroke; Unfavorable outcome.