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.