Clinical, Biochemical and Neuroimaging Parameters after Thrombolytic Therapy Predict Long-Term Stroke Outcome

Introduction: We investigated the predictive value of standard neurological evaluation, a commercially available biomarker assay and neuroimaging in the subacute phase for outcome after thrombolytic therapy in ischemic stroke. Methods: Thirty-four consecutive ischemic stroke patients were evaluated by means of the NIH Stroke Scale (NIHSS72), the Triage (R) Stroke Panel (MMX72) and standardized infarct volumetry at 72 h after treatment with intravenous recombinant tissue plasminogen activator or intra-arterial urokinase. Outcome was assessed by the modified Rankin Scale (mRS) at 3 months after the stroke. Results: NIHSS72, MMX72 and infarct volume correlated significantly with the mRS score at month 3 and emerged as independent outcome predictors from logistic regression analysis. NIHSS72 is the best predictor for outcome, but its accuracy increases by 9 and 6% when combined with MMX72 and infarct volumetry, respectively. The combined use of NIHSS72 and MMX72 allows long-term outcome prediction with 97% accuracy, which is not further improved by infarct volumetry. Conclusions: Routine clinical evaluation, bedside testing of biochemical markers by the Triage Stroke Panel and infarct volumetry on neuroimaging at 72 h after thrombolytic therapy are predictors for long-term outcome of ischemic stroke patients. Clinical assessment is the most reliable parameter for outcome prediction, but its predictive value is substantially improved when combined with the biomarker panel. Copyright (C) 2009 S. Karger AG, Basel