Risk prediction model for poor prognosis after intravenous thrombolysis among ischemic stroke patients aged ≥ 80 years and analysis of follow-up

Sci Rep. 2025 Jan 8;15(1):1354. doi: 10.1038/s41598-024-84912-0.

Abstract

To develop and validate practical prediction tools to estimate poor outcomes in patients ≥ 80 years old with acute ischemic stroke after intravenous alteplase thrombolysis, aiding clinical decision-making.To explore the longest benefit window after thrombolysis in the elderly. 1: A retrospectively analysis was conducted on acute stroke patients who underwent intravenous thrombolysis. Patients aged ≥ 80 years were compared to those aged 60-79 years, with a focus on the incidence of symptomatic intracranial hemorrhage, mortality, and poor functional outcome (modified Rankin Score ≥ 2 at 90 days post-thrombolysis). R software was utilized to develop a clinical prediction model and perform internal validation. 2: Ninety days, 180 days, and one year were designated as follow-up time points for all patients. 1.Patients aged ≥ 80 years had higher 90-day poor outcome and mortality (P < 0.001).However, there was no significant difference in symptomatic intracranial hemorrhage between the two groups (P > 0.05).Baseline NIHSS score (OR, 1.15; 95% CI,1.07-1.23; P < 0.001) and admission blood glucose (OR, 1.36; 95% CI,1.11-1.74; P = 0.007) were identified as independent predictors of poor prognosis at 90 days.The area of the prediction model under the receiver operator characteristic curve was 0.77. An online prognostic calculator was developed.2.There was no further improvement in mRS Score in the elderly group after 180days (P < 0.05). (1)The prediction model can estimate the poor outcome of patients aged ≥ 80 years with acute ischemic stroke after intravenous alteplase thrombolysis.The predictors are readily derived at admission.The prediction calculator( https://80ivtr.shinyapps.io/dynnomapp/ ) can be used as a popular tool for physicians. (2)The total duration of benefit after intravenous thrombolysis for patients aged ≥ 80 years is 180 days, while it is at least 1 year for patients between 60 and 79 years.

Keywords: Prediction models; Aged ≥ 80 years; Follow-up; Intravenous thrombolysis; Ischemic stroke.

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aged, 80 and over
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use
  • Follow-Up Studies
  • Humans
  • Ischemic Stroke* / drug therapy
  • Ischemic Stroke* / mortality
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Thrombolytic Therapy* / methods
  • Tissue Plasminogen Activator* / administration & dosage
  • Tissue Plasminogen Activator* / therapeutic use
  • Treatment Outcome

Substances

  • Tissue Plasminogen Activator
  • Fibrinolytic Agents