CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury

Huijuan Jin; Rentang Bi; Yifan Zhou; Qinghui Xiao; Min Li; Shuai Sun; Jinghua Zhou; Jichuan Hu; Ming Huang; Yanan Li; Candong Hong; Shengcai Chen; Jiang Chang; Yan Wan; Bo Hu

doi:10.3389/fneur.2023.1266526

CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury

Front Neurol. 2023 Sep 21:14:1266526. doi: 10.3389/fneur.2023.1266526. eCollection 2023.

Authors

Huijuan Jin¹, Rentang Bi¹, Yifan Zhou¹, Qinghui Xiao¹, Min Li², Shuai Sun¹, Jinghua Zhou³, Jichuan Hu⁴, Ming Huang⁵, Yanan Li¹, Candong Hong¹, Shengcai Chen¹, Jiang Chang⁶, Yan Wan¹, Bo Hu¹

Affiliations

¹ Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Neurology, The Second People's Hospital of China Three Gorges University, Yichang, China.
³ Department of Neurology, The First Clinical Medical College of China Three Gorges University, Yichang, China.
⁴ Department of Neurology, People's Hospital of Dongxihu District, Wuhan, China.
⁵ Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China.
⁶ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

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.

Keywords: acute ischemic stroke; clinical interventions; early neurological deterioration; intravenous thrombolysis; scale.