Analysis Of Related Factors Of Early Neurological Deterioration After Intravenous Thrombolysis In Acute Ischemic Stroke

Objective: To explore the correlation between different risk factors and early neurological deterioration after intravenous thrombolysis.Methods: The general data,imaging data and laboratory data of ischemic stroke patients who received intravenous thrombolysis in the First Affiliated Hospital of China Medical University from July 1,2019 to September 30,2020 and hospitalized in the Department of Neurology were collected and analyzed.The NIHSS(National Institute of Health stroke scale)score on admission was used to evaluate the neurological impairment and the incidence of END(early neurological deterioration).The diagnostic criteria of END was that the NIHSS score increased ≥ 4 points within 24 hours after intravenous thrombolytic therapy.The data were processed by SPSS 23.0 software,and the general data,clinical data and laboratory data of early neurological deterioration group and non-early neurological deterioration group were compared.Logistic stepwise regression analysis was used to screen the independent risk factors of early neurological deterioration,and we constructed END prediction model by nomogram.Results: A total of 187 subjects were included in this study,including 137 male patients and 50 female patients.The average age of onset was 61.21 ±12.63 years old.A total of 36 patients had early neurological deterioration,accounting for 19.25%.Univariate analysis showed that in END group and non-END group,there were significant differences in DBP(diastolic blood pressure)at admission(P=0.038),NIHSS score before thrombolysis and 24 hours after thrombolysis(P=0.007;P<0.001),large-artery atherosclerosis(P=0.003),CRP(C-reactive protein)(P=0.023),basal ganglia infarction(P=0.005),moderate and severe leukoaraiosis(P =0.037),brain atrophy(P=0.016),and good collateral circulation(P=0.008).Using Logistic stepwise regression analysis,it was found that diastolic blood pressure at admission(OR=1.04,95%CI 1.01-1.07),large-artery atherosclerosis(OR=4.34,95%CI 1.82-10.32),and leukoaraiosis(OR=2.97,95%CI 1.2-7.36)were independent predictors of END.Based on these three independent risk factors,a nomogram prediction model was constructed,and its Cindex was 0.744.The area under the ROC curve of the model is 0.74(95%CI: 0.66-0.83).Conclusion: The incidence of early neurological deterioration in patients with ischemic stroke after intravenous thrombolysis was 19.25%.Patients with higher diastolic blood pressure at admission,large-artery atherosclerosis,moderate and severe leukoaraiosis were more likely to develop early neurological deterioration.The nomogram prediction model based on these three independent risk factors had good prediction ability.