Predictive significance of multiple organ dysfunction severity in patients with severe ischemic stroke: a prospective observational study

The aim of the study to assess the predictive significance of the severity of MOD in patients with severe AIS. The observational two-center prospective study included 140 patients with severe AIS. The SAPS II scale has the greatest predictive significance (area under curve (AUC) 0.719). Also, a satisfactory predictor value is characterized by a score on the SOFA scale for 1 day (AUC 0.706). In a comparative analysis of the predictor significance of the SAPS II scale in various pathogenetic variants, in the cardioembolic variant, the predictor significance was higher in comparison with the atherothrombotic variant of AIS (AUC 0.808 and 0.667, respectively). A three-dimensional regression model was obtained for the dependence of the probable mortality on the 28th day of the disease on the severity of stroke on the NIHSS scale on the first day and the dynamics of severity from day 1 to day 5, measured on the SOFA scale.本研究旨在评估多器官功能障碍（Multiple Organ Dysfunction, MOD）严重程度对重症急性缺血性卒中（Acute Ischemic Stroke, AIS）患者的预测价值。本项双中心前瞻性观察研究共纳入140例重症急性缺血性卒中患者。其中，简化急性生理学评分II（Simplified Acute Physiology Score II, SAPS II）展现出最优的预测效能，其曲线下面积（Area Under Curve, AUC）为0.719；入院第1天的序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA）同样具备令人满意的预测价值，对应的AUC为0.706。在对比不同发病机制亚型的SAPS II预测价值时发现，在心源性栓塞型急性缺血性卒中患者中，该评分的预测价值显著高于动脉粥样硬化血栓形成型患者，二者对应的AUC分别为0.808和0.667。本研究构建了疾病28天死亡概率的三维回归模型，该模型以发病第1天美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评估的卒中严重程度，以及第1天至第5天通过SOFA评分测量的严重程度动态变化作为核心预测变量。