Prognostic Nomogram for Patients with Large Vessel Occlusion Undergoing EVT

Among patients with acute ischemic stroke with large vessel occlusion (LVO) who have received endovascular thrombectomy, a recently designed graphical representation consistently predicted patient recovery in social and work-related functioning. Additionally, their Controlling Nutritional Status (CONUT) score, an objective nutritional index, was linked to poor functional outcomes. These findings were published in Nutrition, Metabolism and Cardiovascular Diseases.

Preserved nutritional status, if assessed effectively, can be an important prognostic tool in many patients. Such effective methodology has been lacking among patients with LVO receiving endovascular thrombectomy (EVT). While EVT is effective clinically, more than half of the patients who receive this procedure resolve in poor functional outcomes. Researchers sought to examine objective nutritional indexes in patients with LVO following EVT, with a goal of developing an effective nomogram for functional outcomes to assist in stroke management.

To accomplish this, they conducted a retrospective random cohort study from February 2016 to November 2020 of 418 LVO patients (median aged 70, IQR 59-78; 45% women) at the tertiary stroke center, West China Hospital, Sichuan University, Chengdu, China, who underwent EVT. The patients were randomly assigned into a training cohort (n=293) and a validation cohort (n=125) but balanced for clinical and demographic traits. Computed objective nutritional indexes included the Controlling Nutritional Status (CONUT) score, Nutritional Risk Index (NRI), and Prognostic Nutritional Index (PNI). Using a regression model constructed with independent variables including the CONUT, 7 other factors, plus an estimation of prediction error, a nomogram was developed for a 3-month poor functional outcome.

The 3-month poor functional outcome was related to the CONUT score (odds ratio [OR], 1.387; 95% CI, 1.133-1.698; P =.002). The nomogram area under the curve (AUC) was 0.847 (95% CI, 0.799-0.894) for the training cohort and 0.836 (95% CI, 0.755-0.916) for the validation cohort. This confirmed the effectiveness of the nomogram. The new nomogram more efficiently predicted functional performance than previous predictive models.

Study limitations included the single-center retrospective design, only evaluating objective nutritional indexes upon admission whereas some patients may have subsequently received statins, and caloric intake was not accounted for.

Researchers wrote, “The CONUT independently related to the poor functional outcome, and the newly established nomogram reliably predicted the functional outcome in LVO patients after EVT.”

Reference

Luo Y, Li Y, Dong S, et al. Development and validation of a prognostic nomogram based on objective nutritional indexes in ischemic stroke patients with large vessel occlusion undergoing endovascular thrombectomy. Nutr Metab Cardiovasc Dis. Published online April 13, 2022. doi:10.1016/j.numecd.2022.03.029

This article originally appeared on The Cardiology Advisor