Clinical prediction model for early neurological deterioration in patients with mild nondisabling ischemic stroke within 4.5 hours of onset

Abstract

Objectives: This study aimed to develop a clinical prediction model of early neurologic deterioration in patients with acute mild nondisabling ischemic stroke within 4.5 h of onset.

Patients and methods: In this prospective cohort study, patients with mild nondisabling ischemic stroke who were admitted within 4.5 h of onset between January 1, 2023, and December 31, 2024, were divided into the early neurologic deterioration group and the nonearly neurologic deterioration group based on the NIHSS (National Institutes of Health Stroke Scale) score within 72 h. The clinical data and imaging data of the patients during their emergency visits were collected. A clinical prediction model of early neurologic deterioration was established. Discrimination, calibration, and the net benefit of the model were assessed.

Results: A total of 489 patients were included, of which 422 were in the nonearly neurologic deterioration group and 67 were in the early neurologic deterioration group. Binary Logistic regression analysis showed that systolic blood pressure (odds ratio [OR] = 1.017, p = 0.012), onset-to-treatment time (OR = 1.473), the neutrophil/lymphocyte ratio (OR = 1.017), random blood glucose level (OR = 1.103), number of lesions (OR = 1.480), and vascular stenosis (OR = 1.879) were independent risk factors for early neurologic deterioration (p < 0.05). The area under the receiver operating characteristic curve of the model was 0.754 (95% confidence interval 0.692–0.816, p < 0.001). The prediction accuracy of the model was 87.3%. Hosmer-Lemeshow test yielded a chi-squared value of 4.313 (p = 0.828). The clinical decision cure of the model was higher than the two extreme lines.

Conclusion: Onset-to-treatment time, vascular stenosis, number of new lesions, random blood glucose level, systolic blood pressure, and the neutrophil-to-lymphocyte ratio were independent risk factors for early neurologic deterioration. We developed a simple model for predicting early neurologic deterioration of acute mild nondisabling ischemic stroke within 72 h.

Cite this article as: Lu L, Ma H. Clinical prediction model for early neurological deterioration in patients with mild nondisabling ischemic stroke within 4.5 hours of onset. Turk J Neurol 2026;32(1):27-36. https://doi.org/10.55697/tnd.2026.575.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

H.M., L.L.: Designed the study and contributed to the construction and management of the database; L.L.: Performed the statistical analysis and wrote the manuscript of the manuscript; H.M.: Contributed to the revision, and provided overall oversight of the research, and acted as the guarantor who accepted full responsibility for the work and the conduct of the study. All authors read and approved the final manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

This study was supported by the Medical Science Research Project of Hebei, China (Grant No. 20231774).

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

We thank all participants for their important contributions in this study.