The VITAL_MCE Score: A Simple Model for Predicting Malignant Cerebral Edema After Anterior Circulation Large Vessel Occlusion
Jianping Yu, Zhenyu Shang, Jiexin Li, Bozhi Zhang, Xinrui Cai, Lingjuan Li, Yunli Luo, Peiru Yuan, Jiamin Zhang, Xinyue Mu, Yiran Chen, Qin YangBackground
Malignant cerebral edema (MCE) is a devastating complication of acute ischemic stroke caused by large vessel occlusion (LVO) and is associated with substantial mortality and disability. Early identification of patients at high risk of MCE is essential for timely intervention.
Objectives
We aimed to develop and externally validate a simple model for predicting MCE after anterior circulation LVO.
Design
This was a prospective cohort study in two hospitals.
Methods
Patients with anterior circulation large vessel occlusion within 24 hours of onset were enrolled between November 2023 and December 2025. MCE was defined as midline shift ≥ 5 mm or decompressive hemicraniectomy. We use multivariate logistic regression to choose independent risk factors and develop a new score according to the regression coefficients. Model performance was validated and compared with previous prediction models in another independent cohort using receiver operating characteristic analysis and Area Under Curve (AUC), calibration, decision curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI) and Brier score.
Results
We developed a novel predictive model, termed the VITAL_MCE score, incorporating five readily available predictors: infarct volume (V, > 129 ml = 2, β = 1.874), internal carotid artery involvement (I, yes = 1, β = 1.258), baseline National Institutes of Health Stroke Scale score (T, > 10.5 = 2, β = 2.172), HbA1c (A, > 6.05% = 1, β = 0.981), peripheral lymphocyte (L, < 1.375 × 10 9 /L = 2, β = 2.107). The VITAL-MCE model showed the best discrimination (AUC 0.757, 95% CI 0.611-0.902) and the lowest prediction error (Brier 0.170, Slope 0.67) in external validation, indicating its good generalization ability. No statistically significant differences were found in the NRI or IDI comparison between the models.
Conclusions
The VITAL_MCE score is a simple, robust, and clinically applicable tool for early identification of patients at high risk of developing MCE after LVO-related AIS. It was not inferior to other published models in terms of net weight classification improvement. Further confirmation is needed in large sample multi center data.