Jan 02, 2024

Public workspaceNovel Clinical Prediction Model: Integrating A2DS2score with 24-hour ASPECTS and Red Cell Distribution Width for EnhancedPrediction of Stroke-Associated Pneumonia following Intravenous Thrombolysis

DOI
dx.doi.org/10.17504/protocols.io.rm7vzxeyrgx1/v1
  • Sarawut Krongsut1,
  • Atiwat Soontornpun2,
  • Niyada Anusasnee3
  • 1Division of Neurology, Department of Internal Medicine, Faculty of Medicine Saraburi Hospital, Saraburi, Thailand;
  • 2Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;
  • 3Division of radiology, Saraburi Hospital, Saraburi, Thailand
สราวุธ ครองสัตย์
Open access
DOI: dx.doi.org/10.17504/protocols.io.rm7vzxeyrgx1/v1
Protocol Citation: Sarawut Krongsut, Atiwat Soontornpun, Niyada Anusasnee 2024. Novel Clinical Prediction Model: Integrating A2DS2score with 24-hour ASPECTS and Red Cell Distribution Width for EnhancedPrediction of Stroke-Associated Pneumonia following Intravenous Thrombolysis. protocols.io https://dx.doi.org/10.17504/protocols.io.rm7vzxeyrgx1/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License,  which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: January 01, 2024
Last Modified: January 02, 2024
Protocol Integer ID: 92850
Keywords: ASPECTS, A2DS2 score, ischemic stroke, stroke-associated pneumonia, thrombolysis
Funders Acknowledgement:
Medical Education Center at Saraburi Hospital
Grant ID: MC001-2567
Disclaimer
The authors declare no competing interests.
Abstract
Background: Stroke-associated pneumonia (SAP) is a common leading cause of death during the acute phase. The A2DS2 score has been widely used to predict the risk of SAP. However, 24-hour non-contrast computed tomography-Alberta Stroke Program Early CT Score (NCCT-ASPECTS) and red cell distribution width (RDW) were not included in this scale. The purpose of the present study was to investigate the prognostic added value of combining 24-hour NCCT-ASPECTS and RDW with the A2DS2 score.
Methods: A retrospective study of thrombolyzed acute ischemic stroke (AIS) patients from January 2015 to July 2022. Data on A2DS2 scores, 24-hour NCCT-ASPECTS, and RDW were collected. Three logistic regression models were created: Model A used only the traditional A2DS2 score; Model B (A2DS2-c) calculated probabilities using a logistic equation; and Model C (combined A2DS2-MFP) used multivariable fractional polynomial logistic regression and incorporated the A2DS2 score, 24-hour NCCT-ASPECTS, and RDW. Ischemic brain lesions in the middle cerebral artery area were assessed using 24-hour NCCT-ASPECTS after completing 24-hour intravenous thrombolysis.
Results: Among a cohort of 345 thrombolyzed AIS patients, 70 individuals (20.3%) experienced SAP. The area under the receiver operating characteristic (AuROC) of 24-hour NCCT-ASPECTS and RDW were 0.841 and 0.621, respectively. The combined A2DS2-MFP calculation was significantly superior to the traditional A2DS2 score and A2DS2-c calculation (AuROC 0.917 vs. 0.880, P=0.026, and 0.917 vs. 0.888, P=0.024).
Conclusion: This study found that the 24-hour NCCT-ASPECTS and RDW enhanced the predictive value of the A2DS2 score for SAP after IV-tPA. The combined A2DS2-MFP model performed excellently in predictive performance, offering robust early SAP detection and potentially improving patient survival. Implementing this novel model in resource-constrained clinical settings could aid clinicians in effective monitoring, enabling risk stratification to guide clinical management.
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Novel Clinical Prediction Model: Integrating A2DS2 score with 24-hour ASPECTS and Red Cell Distribution Width for Enhanced Prediction of Stroke-Associated Pneumonia following Intravenous Thrombolysis
Protocol references
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