Cerebral autoregulation in patients with acute lacunar infarction: a reliable predictor of outcome

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2025-02-11 DOI:10.1002/acn3.70004

Xiang-Kun Si, Song Xue, Xin Zhou, Ya-Nan Guo, Wen-Yu Du, Yang Qu, Xin Sun, Zhen-Ni Guo

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Abstract

Objective

To further investigate the association between dynamic cerebral autoregulation (dCA) and the outcomes in patients with acute lacunar infarction.

Methods

Patients were prospectively and consecutively enrolled at The First Hospital of Jilin University between 2016 and 2023. dCA was monitored at 1–3 and 7–10 days after the stroke. The outcomes were evaluated using a 3-month modified Rankin Scale score. Binary and ordered logistic regression were employed to analyze the relationship between dCA parameters and outcomes. dCA-based nomogram models were also developed to assess the predictive value of dCA for these patients.

Results

Overall, 332 patients were included in analysis. dCA showed no significant differences between bilateral cerebral hemispheres, as well as two measurement time points (all P > 0.05). Regression analyses showed that dCA at 1–3 and 7–10 days were independently associated with the outcomes of patients with acute lacunar infarction after adjusting for confounders (all P < 0.05). Incorporating dCA parameters into conventional risk factors enhanced the risk-predictive ability of a 3-month unfavorable outcome, significantly improving the area under the receiver operating characteristic curve from 0.798(95% confidence interval [CI], 0.748-0.848) to 0.829(95% CI, 0.783-0.875) (P = 0.046).

Interpretation

dCA remained consistent in bilateral cerebral hemispheres within acute and subacute periods among patients with lacunar infarction. It was independently associated with 3-month outcomes and could be regarded as a reliable predictor for discriminating outcome.

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急性腔隙性脑梗塞患者的大脑自动调节：预示预后的可靠指标。

目的：进一步探讨脑动态自动调节（dCA）与急性腔隙性梗死预后的关系。方法：2016 - 2023年在吉林大学第一医院前瞻性连续入组患者。分别于卒中后1-3天和7-10天监测dCA。使用3个月修正兰金量表评分评估结果。采用二元和有序逻辑回归分析dCA参数与预后的关系。我们还开发了基于dCA的nomogram模型来评估dCA对这些患者的预测价值。结果：共纳入332例患者。dCA在双侧大脑半球及两个测量时间点间差异无统计学意义（P < 0.05）。回归分析显示，在调整混杂因素后，1-3天和7-10天的dCA与急性腔隙性梗死患者的预后独立相关（均为P）。解释：在腔隙性梗死患者的急性和亚急性期，双侧大脑半球的dCA保持一致。它与3个月的预后独立相关，可作为判别预后的可靠预测因子。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.