Abstract
Introduction
Patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (IVT) for ischemic stroke are monitored in an intensive care unit (ICU) or a comparable unit capable of ICU interventions due to the high frequency of standardized neurological exams and vital sign checks. The present study evaluates quantitative infarct volume on early post-IVT MRI as a predictor of critical care needs and aims to identify patients who may not require resource intense monitoring.
Methods
We identified 46 patients who underwent MRI within 6 h of IVT. Infarct volume was measured using semiautomated software. Logistic regression and receiver operating characteristics (ROC) analysis were used to determine factors associated with ICU needs.
Results
Infarct volume was an independent predictor of ICU need after adjusting for age, sex, race, systolic blood pressure, NIH Stroke Scale (NIHSS), and coronary artery disease (odds ratio 1.031 per cm3 increase in volume, 95 % confidence interval [CI] 1.004–1.058, p = 0.024). The ROC curve with infarct volume alone achieved an area under the curve (AUC) of 0.766 (95 % CI 0.605–0.927), while the AUC was 0.906 (95 % CI 0.814–0.998) after adjusting for race, systolic blood pressure, and NIHSS. Maximum Youden index calculations identified an optimal infarct volume cut point of 6.8 cm3 (sensitivity 75.0 %, specificity 76.7 %). Infarct volume greater than 3 cm3 predicted need for critical care interventions with 81.3 % sensitivity and 66.7 % specificity.
Conclusion
Infarct volume may predict needs for ICU monitoring and interventions in stroke patients treated with IVT.
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Acknowledgments
RF was supported by an R25 Grant-NIH/NINDS Research Education Program for Residents and Fellows in Neurology and Neurosurgery.
Ethical standards and patient consent
We declare that all human studies have been approved by the Johns Hopkins University School of Medicine Institutional Review Board (IRB) and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that we are permitted to use and disclose protected health information in our stroke database via an IRB-approved HIPAA waiver of the requirement for patients’ authorization.
Conflict of interest
VCU is the PI for the investigator initiated trial SAIL ON (a pilot clinical trial of IVT treatment for patients that wake up with stroke); Genentec Inc. has provided funding for this trial. VCU is the PI at Johns Hopkins for the multicenter clinical trial DIAS 4, sponsored by Lundbeck. We declare that there are no patents, products in development, or marketed products.
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Faigle, R., Wozniak, A.W., Marsh, E.B. et al. Infarct volume predicts critical care needs in stroke patients treated with intravenous thrombolysis. Neuroradiology 57, 171–178 (2015). https://doi.org/10.1007/s00234-014-1453-9
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DOI: https://doi.org/10.1007/s00234-014-1453-9