Factors of clot burden and its correlation with clinical outcome in acute ischemic stroke

doi:10.11817/j.issn.1673-9248.2021.05.007

Abstract

Abstract:

Objective

To retrospectively analyze the factors influencing clot burden in patients with acute ischemic stroke (AIS) and evaluate the correlation between clot burden and outcome.

Methods

The baseline clinical dates of 88 patients with AIS admitted to North district of Suzhou Municipal Hospital from January 2019 to June 2020 were collected. According to the clot burden score (CBS), the patients were divided into high clot burden group (CBS 0-6) and low clot burden group (CBS 7-10), and the factors influencing CBS were analyzed by univariate analysis and multivariate Logistic regression model. Regional leptomeningeal score (rLMC), imaging characteristics and clinical outcomes were collected, then the correlation between clot burden and clinical outcomes were evaluated by χ² test and the predictive value of CBS to outcome were calculated by receiver operating characteristic (ROC) curve.

Results

Among the 88 patients, 36 cases (40.9%) were in the high clot burden group and 52 cases (59.1%) were in the low clot burden group. Univariate analysis showed significant differences in history of atrial fibrillation (33.3% vs 13.5%), baseline National Institutes of Health stroke scale (NIHSS) score [11.0 (6.5, 17.5) points vs 9.5(5.5, 14.0) points], time from onset to CT angiography and CT perfusion imaging [380 (190, 525) min vs 408 (180, 610) min], core infarction area [21.62 (15.71, 42.26）ml vs 11.18 (6.18, 14.30) ml] and rLMC [(8.36±2.90) points vs(16.85±1.46) points] between the two groups (χ²=4.926, P=0.026; Z=3.682, P=0.031; Z=3.508, P=0.044; Z=3.115, P=0.039; t=-16.192, P＜0.001). Multivariate Logistic regression model analysis showed a history of atrial fibrillation [odds ratio (OR)=1.944, 95% confidence interval (CI): 1.101-2.431; P=0.022], a high baseline NIHSS score (OR=1.326, 95%CI: 1.036-1.696; P=0.025) and larger core infarction area (OR=1.120, 95%CI: 1.011-1.367; P=0.034) were independent risk factors for high clot burden. A high rLMC was inhibitory factor for high clot burden (OR=0.571, 95%CI: 0.372-0.801; P=0.016). The 90-day good outcome in the low clot burden group was significantly more frequent than that in the high clot burden group (42.3% vs 16.7%; χ²=4.947, P=0.026), while the conversion rate of intracerebral hemorrhage in the former group was significantly lower than that in the latter group (1.9% vs 13.9%; χ²=4.794, P=0.029). However, there was no significant difference in all-cause mortality between the two groups (P＞0.05). The area under the curve for CBS prediction of clinical outcome was 0.784 (95%CI: 0.606-0.862; P＜0.001) with the best cutoff value of 6.5, the sensitivity of 78.1%, and the specificity of 69.4%.

Conclusion

A history of atrial fibrillation, high baseline NIHSS score and large core infarction area volume were independent risk factors, while high rLMC was inhibitory factor for high clot burden in AIS. Patients with low clot burden are more likely to have good outcome, and CBS had a good predictive value for clinical outcome of AIS.

Key words: Acute ischemic stroke, Clot burden, Influencing factors, Outcome

Xuehong Jin, Shaofang Pei, Hong Zhang, Xiaohan Yao, Yongquan Gu. Factors of clot burden and its correlation with clinical outcome in acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(05): 308-313.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.11817/j.issn.1673-9248.2021.05.007

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2021/V15/I05/308

Figures/Tables 5

变量	高血栓负荷组（n=36）	低血栓负荷组（n=52）	统计值	P值
年龄（岁， $x ¯$ ±s）	62.12±9.84	64.01±10.22	t=-1.968	0.192
性别[男（例）%]	19（52.8）	29（55.8）	χ²=0.077	0.782
糖尿病[（例）%]	22（61.1）	21（40.4）	χ²=3.657	0.056
高血压病[（例）%]	22（61.1）	40（76.9）	χ²=2.555	0.110
高脂血症[（例）%]	18（50.0）	33（63.5）	χ²=1.582	0.208
心房颤动史[（例）%]	12（33.3）	7（13.5）	χ²=4.926	0.026
缺血性卒中史[（例）%]	9（25.0）	10（19.2）	χ²=0.418	0.518
吸烟史[（例）%]	11（30.6）	19（36.5）	χ²=0.339	0.560
急诊血糖[mmol/L，M（Q_R）]	8.22（6.32，11.15）	8.01（5.44，10.78）	Z=0.336	0.731
血小板（×10⁹/L， $x ¯$ ±s）	194.21±72.11	189.21±66.24	t=0.961	0.379
纤维蛋白原（g/L， $x ¯$ ±s）	2.43±0.62	2.24±0.71	t=1.132	0.298
D-二聚体（mg/L， $x ¯$ ±s）	0.59±0.12	0.53±0.09	t=0.988	0.351
同型半胱氨酸（mmol/L， $x ¯$ ±s）	9.14±1.26	10.02±1.74	t=-1.769	0.225
基线NIHSS评分[分，M（Q_R）]	11.0（6.5，17.5）	9.5（5.5，14.0）	Z=3.682	0.031
发病至CTA和CTP检查时间[min，M（Q_R）]	380（190，525）	408（180，610）	Z=3.508	0.044
缺血半暗带体积[ml，M（Q_R）]	11.26（8.33，16.17）	13.37（8.48，20.15）	Z=-0.364	0.709
核心梗死区体积[ml，M（Q_R）]	21.62（15.71，42.26）	11.18（6.18，14.30）	Z=3.115	0.039
rLMC[分， $x ¯$ ±s]	8.36±2.90	16.85±1.46	t=-16.192	＜0.001

变量	高血栓负荷组（n=36）	低血栓负荷组（n=52）	统计值	P值
年龄（岁， $x ¯$ ±s）	62.12±9.84	64.01±10.22	t=-1.968	0.192
性别[男（例）%]	19（52.8）	29（55.8）	χ²=0.077	0.782
糖尿病[（例）%]	22（61.1）	21（40.4）	χ²=3.657	0.056
高血压病[（例）%]	22（61.1）	40（76.9）	χ²=2.555	0.110
高脂血症[（例）%]	18（50.0）	33（63.5）	χ²=1.582	0.208
心房颤动史[（例）%]	12（33.3）	7（13.5）	χ²=4.926	0.026
缺血性卒中史[（例）%]	9（25.0）	10（19.2）	χ²=0.418	0.518
吸烟史[（例）%]	11（30.6）	19（36.5）	χ²=0.339	0.560
急诊血糖[mmol/L，M（Q_R）]	8.22（6.32，11.15）	8.01（5.44，10.78）	Z=0.336	0.731
血小板（×10⁹/L， $x ¯$ ±s）	194.21±72.11	189.21±66.24	t=0.961	0.379
纤维蛋白原（g/L， $x ¯$ ±s）	2.43±0.62	2.24±0.71	t=1.132	0.298
D-二聚体（mg/L， $x ¯$ ±s）	0.59±0.12	0.53±0.09	t=0.988	0.351
同型半胱氨酸（mmol/L， $x ¯$ ±s）	9.14±1.26	10.02±1.74	t=-1.769	0.225
基线NIHSS评分[分，M（Q_R）]	11.0（6.5，17.5）	9.5（5.5，14.0）	Z=3.682	0.031
发病至CTA和CTP检查时间[min，M（Q_R）]	380（190，525）	408（180，610）	Z=3.508	0.044
缺血半暗带体积[ml，M（Q_R）]	11.26（8.33，16.17）	13.37（8.48，20.15）	Z=-0.364	0.709
核心梗死区体积[ml，M（Q_R）]	21.62（15.71，42.26）	11.18（6.18，14.30）	Z=3.115	0.039
rLMC[分， $x ¯$ ±s]	8.36±2.90	16.85±1.46	t=-16.192	＜0.001

变量	B值	SE值	Wald χ²值	P值	OR值（95%CI）
糖尿病	0.037	0.364	0.010	0.919	0.889（0.096~2.116）
心房颤动史	0.665	0.290	5.255	0.022	1.944（1.101~2.431）
基线NIHSS评分	0.282	0.126	5.032	0.025	1.326（1.036~1.696）
发病至CTA和CTP时间	0.654	0.339	3.623	0.057	0.724（0.019~1.310）
核心梗死区体积	0.713	0.669	4.477	0.034	1.120（1.011~1.367）
rLMC	0.543	0.227	5.766	0.016	0.571（0.372~0.801）

组别	例数	溶栓	溶栓+取栓/单纯取栓	抗栓	出血转化	全因死亡	恢复良好	抗栓亚组恢复良好
高血栓负荷组	36	6（16.7）	5（13.9）	24（66.7）	5（13.9）	4（11.1）	6（16.7）	2（8.3）
低血栓负荷组	52	9（17.3）	3（5.8）	41（78.8）	1（1.9）	2（3.8）	22（42.3）	13（31.7）
χ²值		0.006	1.697	1.635	4.794	1.767	4.947	4.659
P值		0.937	0.193	0.201	0.029	0.184	0.026	0.031

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