ANGWC Nomogram for Predicting Poor 3-month Outcome after Intravenous Thrombolysis in Young and Middle-aged Patients with First-ever Stroke

The rising prevalence of ischemic stroke among younger individuals is concerning. Despite the significant benefits of intravenous thrombolytic therapy for young and middle-aged patients, the disease burden in this demographic is often overshadowed by that of older patient groups. This study aims to identify the risk factors for poor 3-month outcomes following intravenous thrombolysis in young and middle-aged patients with first-ever stroke and to develop a novel nomogram.This prospective study included patients aged 18 to 59 years with a first ischemic stroke from 16 hospitals. Patients from one of the hospitals were designated as the training cohort. General information and clinical data were compared between the favorable outcome (modified Rankin Scale [mRS] score < 2) and the poor outcome groups (mRS score ≥ 2). Logistic regression analysis was used to develop the nomogram. An additional 113 patients from the other 15 hospitals were recruited as the validation cohort.A total of 217 patients were enrolled in the training cohort, with 47% experiencing poor 3-month outcomes. Five variables were selected to construct the ANGWC (A: ge, N: IHSS score, blood G: lucose, W: hite blood cell count, and total C: holesterol) nomogram. The AUC of the nomogram was 0.802 in the training cohort and 0.747 in the validation cohort. The Hosmer-Lemeshow goodness-of-fit test showed a <i>P</i>-value > 0.05, and calibration curve slopes were close to 1. Decision curve analysis indicated good clinical utility.The ANGWC nomogram provides a reliable prediction of poor 3-month outcomes after intravenous thrombolysis in young and middle-aged patients with first-ever stroke.