Relationship Between Severity Of Leukoencephalopathy And Prognosis Of Patients With Acute Ischemic Stroke

Objective: To investigate the relationship between severity of leukodystrophy and other clinical data and functional prognosis of patients with acute ischemic stroke,and to understand the distribution of severity of leukodystrophy in these patients.Methods: Retrospective analysis was performed on patients diagnosed with acute ischemic stroke by cranial Magnetic Resonance Imaging(MRI)admitted to Ward 1,Department of Neurology,Yijishan Hospital,Wannan Medical College from September 2021 to October 2022.Clinical data of these patients were collected.This includes age,sex,smoking history,drinking history,previous disease history,blood test indicators,etc.According to the patient’s medical history and physical examination using the National Institute of Health Stroke Scale(NIHSS),the degree of neurological impairment was scored at admission.Patients were scored using the Fazekas grade visual scoring method based on the T2-weighted image or Fluid Attenuated Inversion Recovery(FLAIR)sequence in the patient MRI,and patients were classified according to this score.The enrolled patients were followed up by telephone 90 days after discharge.The patients were grouped according to the Modified Rankin Scale(MRs)score of clinical outcome.The patients in the good prognosis group had MRs Score ≤2 points,and the patients in the poor prognosis group had MRs Score > 2 points and died.Results: Finally,334 patients were included in this study,including 224 patients(67.1%)in the good prognosis group and 110 patients(32.9%)in the poor prognosis group.Clinical data of patients with acute ischemic stroke with good prognosis and poor prognosis were compared.Among them,age,history of hypertension,diabetes,atrial fibrillation,previous stroke,Body Mass Index(BMI),NIHSS score,Fibrinogen(FIB),Activated Partial prothrombin kinase time(Activated Partial)Thromboplastin Time(APTT),White Blood Cell(WBC),D-Dimer,D-D),C-Reaction Protein(CRP)and Fazekas scale score were statistically significant in patients with good prognosis and poor prognosis(P<0.05).The results of multivariate binary logistic regression analysis showed that: Age,diabetes history,NIHSS score,FIB,APTT and Fazekas score were independent risk factors for poor prognosis in patients with acute ischemic stroke(P<0.05).Higher scores on the Fazekas scale were significantly associated with poor outcomes in patients with acute ischemic stroke(OR=2.137,95%CI=1.645-2.777,P <0.001).Furthermore,receiver operating characteristic curve(ROC curve)was used to determine the predictive efficacy of Fazekas scale score in predicting adverse outcomes in patients with acute ischemic stroke.The critical value was 2.5,the sensitivity was 0.713,the specificity was 0.843,and the area under the curve was 0.844(95%CI=0.801-0.886).P < 0.001).Conclusion: The more severe the degree of leukoencephalopathy in patients with acute ischemic stroke,the worse the prognosis.