Predictive factors for very poor outcomes after endovascular thrombectomy in anterior circulation large vessel occlusion: a multicentre retrospective study in China
Bibliographic record
Abstract
OBJECTIVE: This study aims to investigate the predictors of very poor outcomes in patients with acute ischaemic stroke due to large vessel occlusion after successful endovascular thrombectomy. DESIGN: multicentre, retrospective study. SETTING: Data were derived from tertiary care facilities in five cities of China. PARTICIPANTS: This study included 1242 patients with anterior circulation large-vessel occlusion who underwent endovascular thrombectomy, and they were stratified by 90-day modified Rankin Scale (mRS) scores into a very poor outcome group (mRS 5-6) and a non-very poor outcome group (mRS 0-4). PRIMARY OUTCOME MEASURES: The primary outcome was very poor outcomes. Data from 1242 patients were analysed for demographic, laboratory, imaging and perioperative data. RESULTS: Among the 1242 recruited patients, 318 (25.60%) exhibited very poor outcomes. In multivariate analysis, predictors of very poor outcomes were higher age (OR 1.059, 95% CI 1.043 to 1.075, p<0.001), stroke history (OR 1.993, 95% CI 1.373 to 2.888, p<0.001), coronary heart disease history(CHD;OR=1.816,95% CI 1.291-2.552,P=0.001),higher baseline National Institute of Health Stroke Scale (NIHSS; OR 1.076, 95% CI 1.054 to 1.099, p<0.001), higher neutrophil count (OR 1.078, 95% CI 1.025 to 1.134, p=0.003), lower Alberta Stroke Program Early CT Score (ASPECTS; OR 0.901, 95% CI 0.845 to 0.962, p=0.002), higher malignant cerebral oedema (MCE, OR 3.246,95% CI 2.241 to 4.713, p<0.001) and symptomatic intracranial haemorrhage (sICH, OR 3.97, 95% CI 2.569 to 6.169, p<0.001) and receiving intravenous thrombolysis (IVT, OR = 0.600,95% CI 0.431-0.830, P =0.002) . The predictive model demonstrated a certain degree of accuracy (area under the curve 0.839, 95% CI 0.813 to 0.864). CONCLUSIONS: The very poor outcomes were associated with advanced age, CHD history, stroke history, high NIHSS score, high neutrophil count, low ASPECTS and presence of MCE and sICH, while receiving intravenous thrombolysis was a protective factor. These poor outcome predictors might play a crucial role in informing clinical decision-making. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT06290076); pre-results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".