Clinical prediction of prognostic outcome of intravenous thrombolysis in mild stroke

Development and validation of an easy-to-visualize nomogram for acute mild ischemic stroke (MIS) with unfavorable outcome 3 months after application of alteplase intravenous thrombolysis. A retrospective cohort study analysis was conducted at the Baoding First Central Hospital, involving 461 patients diagnosed with acute MIS who received alteplase thrombolysis within the treatment time window. The LASSO regression technique was employed to identify significant variables and develop nomograms. The model's performance was assessed through area under curve-receiver operating characteristic curves, calibration plots, and decision curves, followed by a final evaluation of its validity. Five predictors that were found to be significantly associated with a 3-month adverse prognosis in patients who underwent intravenous thrombolysis for mild stroke were identified as door-to-needle time, homocysteine levels, brain natriuretic peptide, postthrombolysis National Institutes of Health Stroke Scale (NIHSS) score (i.e., immediate postthrombolysis NIHSS score, postthrombolysis NIHSS score (P-NIHSS)), and the monocyte to high-density lipoprotein cholesterol ratio. A visualization chart was constructed. The model had strong predictive performance, with an area under curve-receiver operating characteristic curves of 0.904 (95% confidence interval, 0.858-0.944) for the training cohort and 0.852 (95% confidence interval, 0.768-0.917) for the validation cohort. This straightforward predictive model efficiently identifies factors linked to unfavorable prognosis at the 3-month mark following intravenous thrombolytic therapy for acute MIS, thereby enhancing clinical practice and optimizing the distribution of social resources.