SPRIN2D nomogram: predicting 90-day unfavorable outcomes in patients with minor ischemic stroke receiving intravenous thrombolysis

Abstract

Objective This study aimed to construct and validate a nomogram for the intuitive prediction of 90-day unfavorable outcomes in patients with minor ischemic stroke who underwent intravenous thrombolysis. Methods Data were extracted from the Multicenter Clinical Trial of Revascularization Treatment for Acute Ischemic Stroke (TRAIS) study. Multivariable logistic regression was used to identify independent factors associated with 90-day unfavorable outcomes (modified Rankin Scale [mRS] score 2–6) in patients with minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score 0–5) receiving intravenous thrombolysis. A nomogram (designated as SPRIN2D) was developed based on the final prediction model, incorporating 6 key variables: NIHSS score, functional disability, systolic blood pressure, neutrophil count, international normalized ratio and renal dysfunction. Results A total of 1,438 eligible patients were enrolled and randomly assigned to a derivation cohort (n = 1,007) and a validation cohort (n = 431). In the overall cohort, the median age was 65 years (interquartile range, 56–73); 67.94% of participants were male, and the median admission NIHSS score of 2 (interquartile range, 1–4). The SPRIN2D nomogram exhibited robust performance in predicting 90-day unfavorable outcomes in minor ischemic stroke patients treated with intravenous thrombolysis. The area under the curve was 0.784 (95% confidence interval [CI], 0.744–0.822) in the derivation cohort and 0.776 (95% CI, 0.716–0.835) in the validation cohort. Moreover, the SPRIN2D nomogram demonstrated superior discriminative ability compared with other existing prognostic models for acute ischemic stroke and minor ischemic stroke. Conclusion The SPRIN2D nomogram is a stable and promising tool for predicting 90-day unfavorable outcomes in minor ischemic stroke patients treated with intravenous thrombolysis.