Study on the predictive value of fibrinogen combined with NIHSS score in the prognosis of acute ischemic stroke patients treated with intravenous thrombolysis

Objective: To explore the association between pre-thrombolytic fibrinogen (FIB), pre-thrombolytic NIHSS score and near-and medium-term prognosis in acute ischemic stroke(AIS) patients treated with intravenous thrombolysis(IVT), and the predictive efficacy of combining two variables for prognosis. Methods: A total of 167 IVT-treated AIS patients were collected.According to the mRS score, the patients were divided into the good prognosis group(n=123) and poor prognosis group(n=44) at 3 months after onset.The demographic and clinical data between two groups were compared with univariate analysis.Multivariate logistic regression analysis was used to explore the independent factors influencing prognosis.ROC curve was used to analyze the predictive efficacy of FIB and NIHSS score before thrombolysis for near-and medium-term prognosis. Results: A total of 167 subjects were included in this study, including 107 males and 60 females, with an average age of (62.10±11.76) years.There were 28 cases of early neurological deterioration(END), 3 cases of hemorrhagic transformation occurred, and no symptomatic hemorrhagic transformation occurred.There were 123 cases with a good prognosis and 44 cases with a poor prognosis.The results of univariate analysis showed that the FIB, NIHSS score and systolic blood pressure of patients in the poor prognosis group before thrombolysis were higher.The number of END cases and proportion of large artery atherosclerotic type in the TOAST classification in the poor prognosis group were higher than those in good prognosis group(P < 0.05 to P < 0.01).The regression analysis showed that the high FIB level and high NIHSS score before thrombolysis and occurrence of END might be independent risk factors of poor prognosis in the near-and medium-term of AIS(P < 0.01).ROC curve analysis showed that the areas under the curve of the predictive efficacy of pre-thrombolysis FIB, pre-thrombolysis NIHSS score and their combination for prognosis were 0.655, 0.726, and 0.868, respectively. Conclusions: The pre-thrombolysis FIB and pre-thrombolysis NIHSS score are the independent risk factors of poor prognosis in AIS patients treated with intravenous thrombolysis.The combination of the two variables can significantly improve the prediction efficiency of near-and medium-term prognosis.