Deans' stroke musings: Establishment of a dynamic nomogram including thyroid function for predicting the prognosis of acute ischemic stroke with standardized treatment

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, June 26, 2023

Establishment of a dynamic nomogram including thyroid function for predicting the prognosis of acute ischemic stroke with standardized treatment

And somehow in your two functioning brain cells you think predicting damage rather than preventing such damage was worthwhile research?

Establishment of a dynamic nomogram including thyroid function for predicting the prognosis of acute ischemic stroke with standardized treatment

Yi Jiang¹^†,

Chunhui Xie^1,2^†,

Guanghui Zhang²^*,

Mengqian Liu³,

Yiwen Xu³,

Wen Zhong³,

Zhonglin Ge⁴,

Zhonghai Tao⁴,

Mingyue Qian⁴,

Chen Gong³ and

Xiaozhu Shen¹^*

¹Department of Geriatrics, Bengbu Medical College Clinical College of Lianyungang Second People's Hospital, Lianyungang, China
²Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
³Department of Geriatrics, Lianyungang Second People's Hospital Affiliated to Jiangsu University, Lianyungang, China
⁴Department of Neurology, Lianyungang Second People's Hospital, Lianyungang, China

Purpose: Many patients with acute ischemic stroke (AIS) cannot undergo thrombolysis or thrombectomy because they have missed the time window or do not meet the treatment criteria. In addition, there is a lack of an available tool to predict the prognosis of patients with standardized treatment. This study aimed to develop a dynamic nomogram to predict the 3-month poor outcomes in patients with AIS.

Methods: This was a retrospective multicenter study. We collected the clinical data of patients with AIS who underwent standardized treatment at the First People's Hospital of Lianyungang from 1 October 2019 to 31 December 2021 and at the Second People's Hospital of Lianyungang from 1 January 2022 to 17 July 2022. Baseline demographic, clinical, and laboratory information of patients were recorded. The outcome was the 3-month modified Rankin Scale (mRS) score. The least absolute shrinkage and selection operator regression were used to select the optimal predictive factors. Multiple logistic regression was performed to establish the nomogram. A decision curve analysis (DCA) was applied to assess the clinical benefit of the nomogram. The calibration and discrimination properties of the nomogram were validated by calibration plots and the concordance index.

Results: A total of 823 eligible patients were enrolled. The final model included gender (male; OR 0.555; 95% CI, 0.378–0.813), systolic blood pressure (SBP; OR 1.006; 95% CI, 0.996–1.016), free triiodothyronine (FT3; OR 0.841; 95% CI, 0.629–1.124), National Institutes of Health stroke scale (NIHSS; OR 18.074; 95% CI, 12.264–27.054), Trial of Org 10172 in Acute Stroke Treatment (TOAST; cardioembolic (OR 0.736; 95% CI, 0.396–1.36); and other subtypes (OR 0.398; 95% CI, 0.257–0.609). The nomogram showed good calibration and discrimination (C-index, 0.858; 95% CI, 0.830–0.886). DCA confirmed the clinical usefulness of the model. The dynamic nomogram can be obtained at the website: predict model (90-day prognosis of AIS patients).

Conclusion: We established a dynamic nomogram based on gender, SBP, FT3, NIHSS, and TOAST, which calculated the probability of 90-day poor prognosis in AIS patients with standardized treatment.

Introduction

In 2019, the Global Burden of Disease study showed stroke was the second leading cause of death worldwide (1). In the same year, the literature showed that stroke was also the leading cause of death in China (2). In the face of such a heavy disease burden, any assistance provided to clinicians is beneficial. Early prediction of a patient's prognosis can help clinicians choose appropriate treatment options and communicate effectively with patients and their families, thereby improving their quality of life.

Treatment during an AIS attack is closely related to the prognosis. Thrombolysis is currently an important treatment for stroke and provides significant clinical benefits to patients (3, 4), but many patients are excluded because of difficulties in meeting the indications for thrombolysis or embolization. The strict time-window for treatment remained a major limitation (5). A study indicated that 69% of people missed treatment due to delayed admission to the hospital (6). Meanwhile, milder stroke symptoms (NIHSS <6) were also one of the major reasons why patients missed thrombolytic therapy (7).

The prognosis of stroke may be influenced by a variety of factors (8–10). In recent years, many studies have pointed to an association between thyroid hormones and the prognosis of stroke. A study including 702 patients showed that low free triiodothyronine (FT3) levels were independently associated with poor functional outcomes and mortality 3 months after stroke onset (11). A study included 199 patients with AIS identified low thyroid stimulating hormone (TSH) levels as an independent risk factor for adverse outcomes at 3 months (12). Another study that included 848 AIS patients with intracranial atherosclerotic stenosis showed that high free thyroxine (FT4) levels were associated with poor prognosis (13).

These results suggest that we need to consider the possible influence of thyroid hormone levels on stroke when predicting stroke prognosis.

Nomograms are widely used as a tool for visualizing predictive models. However, there is a lack of an available tool to help clinicians predict the prognosis of populations receiving standardized treatment for AIS. This study aimed to develop a predictive model for predicting the severity at discharge of AIS patients with standardized treatment and to develop a tool easily used by clinical staff.