Abstract TP278: Identifying High-Risk Patients With Poor Prognosis in Acute Phase of Ischemic Stroke: Treatment-Specific Risk Scales Developed From the National Neurological Medical Center of China

Background: There is still a lack of acute ischemic stroke (AIS) prognostic prediction scales to assist in more scientific and efficient clinical management of patients.

Objective: Real-world data were utilized to construct and validate an easily popularized prediction score for poor prognosis in the acute phase of AIS so as to provide a basis for clinical monitoring and intervention of specific indicators.

Method: Patients discharged from Huashan Hospital, Fudan University between 2015 and 2021 were consecutively included. AIS with premorbid mRS ≤ 2 within 72 hours of onset was included. Patients treated with arterial thrombectomy were excluded. Subjects were divided into "intravenous thrombolysis group" and "non-intravenous thrombolysis group". Based on the data of discharge patients from 2015 to 2020 (Model Training Set), logistic regression model with restricted cubic splines were applied to construct the "prognostic scale of AIS acute stage based on treatment stratification, PAIST Scale". Performance of the scale was tested using the area under the receiver operating characteristic curve (AUC-ROC) based on data from patients discharged in 2021 (External Validation Set).

Result: A total of 1971 patients (437 thrombolysis) were included. The "PAIST Scale" of the thrombolysis patients included: Baseline NIHSS (5-15 = 11, ≥ 16 = 20), deep vein thrombosis (yes = 5), Neuron specific enolase (> 13 ng/ml = 3), and neutrophil percentage (> 70% = 5). The "PAIST Scale" of the Non-thrombolytic population: Baseline NIHSS (5-15 = 12, ≥ 16 = 20), deep venous thrombosis (yes = 4), Neuron specific enolase (> 12.5 ng/ml = 1), neutrophil percentage (> 66% = 3), age (> 64y = 2), fasting blood glucose (> 5.8 mmol/l = 2), serum potassium (< 3.8 mmol/L = 1). In the external validation set, the AUC-ROC values of "PAIST Scale" were 0.855 in the non-thrombolysis group and 0.778 in the thrombolysis group. Meanwhile, patients defined as high-risk by the "PAIST scale" had an actual incidence of poor prognosis of 76.92% in the thrombolysis group (> 19 points) and 61.11% in the non-thrombolysis group (> 17 points).

Conclusion: The "PAIST Scale" established in this study can effectively identify patients at high risk of poor prognosis in the acute phase among patients with mild to moderate stroke.