Evaluation of A Prediction Model for Neurological Deterioration after Thrombolysis in Acute Ischemic Stroke

CHEN Shuang; LU Yuli

doi:10.16458/j.cnki.1007-0893.2025.23.005

Abstract：Objective To analyze the influencing factors of early neurological deterioration(END)after intravenous thrombolysis in patients with acute ischemic stroke(AIS)and to construct a prediction model.Methods A total of 108 AIS patients who received thrombolysis treatment at Nanyang Central Hospital from April 2022 to April 2025 were selected as the study subjects(training set).All patients received the same standard intravenous thrombolysis treatment and subsequent management.The occurrence of END and general data after thrombolysis were collected.According to whether END occurred within 24 hours after thrombolysis,the patients were divided into the END group and the non-END group.Univariate and multivariate Logistic regression analysis were used to screen the independent risk factors for END,and a prediction model was constructed based on these factors.The receiver operating characteristic(ROC)curve was used to evaluate the discrimination of the model,and the Hosmer-Lemeshow test and calibration curve were used to evaluate the calibration of the model.Another 100 AIS patients were collected to externally validate the model performance.Results Among the 108 AIS patients after thrombolysis,30 cases developed END,with an incidence rate of 27.78%(30/108),and were included in the END group;78 cases did not develop END and were included in the non-END group.The proportion of patients with atrial fibrillation,baseline National Institutes of Health stroke scale(NIHSS)score,red blood cell distribution width(RDW),and serum galectin-3(Gal-3)level in the END group were all higher than those in the non-END group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that atrial fibrillation,baseline NIHSS score,RDW,and elevated Gal-3 level were all independent risk factors for END after thrombolysis in AIS patients(P<0.05).Four risk factors from the multivariate results were used as predictive factors to construct a prediction model.The Hosmer-Lemeshow test showed that the P values for the training set and validation set were 0.415 and 0.533,respectively,indicating that the model had good consistency in predicting END after thrombolysis in AIS patients for both the training set and validation set.Conclusion Atrial fibrillation,baseline NIHSS score,RDW,and elevated Gal-3 level are all independent risk factors for END after thrombolysis in AIS patients.The prediction model established based on these variables has good clinical predictive efficacy.