AUTHOR=Jin Huijuan , Bi Rentang , Zhou Yifan , Xiao Qinghui , Li Min , Sun Shuai , Zhou Jinghua , Hu Jichuan , Huang Ming , Li Yanan , Hong Candong , Chen Shengcai , Chang Jiang , Wan Yan , Hu Bo TITLE=CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury JOURNAL=Frontiers in Neurology VOLUME=Volume 14 - 2023 YEAR=2023 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1266526 DOI=10.3389/fneur.2023.1266526 ISSN=1664-2295 ABSTRACT=Importance

Early neurological deterioration (END) is a critical complication in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis (IVT), with a need for reliable prediction tools to guide clinical interventions.

Objective

This study aimed to develop and validate a rating scale, utilizing clinical variables and multisystem laboratory evaluation, to predict END after IVT.

Design, setting, and participants

The Clinical Trial of Revascularization Treatment for Acute Ischemic Stroke (TRAIS) cohort enrolled consecutive AIS patients from 14 stroke centers in China (Jan 2018 to Jun 2022).

Outcomes

END defined as NIHSS score increase >4 points or death within 24 h of stroke onset.

Results

1,213 patients (751 in the derivation cohort, 462 in the validation cohort) were included. The CNS-LAND score, a 9-point scale comprising seven variables (CK-MB, NIHSS score, systolic blood pressure, LDH, ALT, neutrophil, and D-dimer), demonstrated excellent differentiation of END (derivation cohort C statistic: 0.862; 95% CI: 0.796–0.928) and successful external validation (validation cohort C statistic: 0.851; 95% CI: 0.814–0.882). Risk stratification showed END risks of 2.1% vs. 29.5% (derivation cohort) and 2.6% vs. 31.2% (validation cohort) for scores 0–3 and 4–9, respectively.

Conclusion

CNS-LAND score is a reliable predictor of END risk in AIS patients receiving IVT.