Risk factors for poor prognosis in patients with cortical laminar necrosis and establishment of their prediction model: A retrospective cohort study.
Higher admission NIHSS scores, greater severity of white matter hyperintensity, and increased anterior cerebral artery stenosis are associated with poorer outcomes in patients with cortical laminar necrosis after cerebral infarction.
Where it sits
this study against the rest of the afamelanotide corpusSummary and findings
This study analyzed risk factors for poor prognosis in 80 patients with cortical laminar necrosis (CLN) following cerebral infarction. The modified Rankin Scale (mRS) was used to assess functional outcomes at 90 days post-symptom onset. Significant predictors of poor outcomes included higher admission NIHSS score, greater severity of white matter hyperintensity, and increased degree of anterior cerebral artery stenosis.
Abstract
Cortical laminar necrosis (CLN) is a rare form of ischemic necrosis characterized by laminar damage primarily affecting the third to fifth cortical layers. CLN typically follows cerebral infarction but can also arise from various conditions. However, research on CLN is scarce, and predictive models have not yet been established, limiting clinical guidance. We aimed to analyze the risk factors for poor prognosis in patients with CLN after cerebral infarction and to construct a visual nomogram model with early predictive value. This retrospective study included 80 patients admitted to our hospital between January 2019 and December 2024. The modified Rankin Scale (mRS) was used to assess functional outcomes at 90 days after symptom onset. Clinical and imaging data were compared between patients with favorable outcomes (mRS 0-2, n = 56) and those with poor outcomes (mRS 3-6, n = 24). Independent risk factors for poor outcomes were identified through multivariable logistic regression analysis. R software was used to generate a nomogram; the model was evaluated and internally validated. Compared with the favorable outcome group, the poor outcome group had significantly higher age, admission National Institutes of Health Stroke Scale (NIHSS) score, C-reactive protein level, severity of white matter hyperintensity (WMH), and the degree of anterior cerebral artery (ACA) stenosis. Body mass index and albumin levels were significantly lower in the poor outcome than in the favorable outcome group (all P < .05). Admission NIHSS score (odds ratio [OR] = 1.317; 95% confidence interval [CI] 1.097-1.669; P = .008), WMH severity (OR = 5.273; 95% CI 1.181-28.519; P = .037), and degree of ACA stenosis (OR = 7.223; 95% CI 1.631-38.985; P = .013) were independent risk factors for poor outcome of CLN. The C-index (0.852) and calibration curve indicated that the nomogram model had high discriminative ability and accuracy. The area under the receiver operating characteristic curve was 0.867 (95% CI 0.811-0.906). Admission NIHSS score, WMH severity, and degree of ACA stenosis were independently and significantly associated with the prognosis of CLN. The nomogram model developed in this study exhibits strong predictive capability and good discriminative ability and accuracy, enhancing prognosis prediction in patients with CLN following cerebral infarction.
Background
Cortical laminar necrosis (CLN) is a rare ischemic condition characterized by specific cortical layer damage, often following cerebral infarction. Prior research on CLN is limited, and no predictive models have been established, which hampers clinical decision-making. This study aims to identify risk factors for poor prognosis in CLN patients and develop a predictive model to enhance clinical guidance.
Methods
This retrospective cohort study included 80 patients admitted between January 2019 and December 2024. The primary outcome measure was the modified Rankin Scale (mRS) at 90 days post-symptom onset. Multivariable logistic regression was used to identify independent risk factors for poor outcomes, and a nomogram model was developed and validated using R software.
Results
The primary endpoint indicated that higher admission NIHSS scores were significantly associated with poor outcomes (OR = 1.317; 95% CI 1.097-1.669; P = .008). Additionally, WMH severity (OR = 5.273; 95% CI 1.181-28.519; P = .037) and ACA stenosis (OR = 7.223; 95% CI 1.631-38.985; P = .013) were identified as significant independent risk factors. The nomogram model demonstrated a C-index of 0.852 and an area under the ROC curve of 0.867 (95% CI 0.811-0.906).
Interpretation
The findings align with existing literature that suggests higher NIHSS scores correlate with worse outcomes in stroke patients. However, the effect sizes, while statistically significant, may not be clinically meaningful for all practitioners. The study's retrospective design and relatively small sample size limit the robustness of the conclusions, suggesting caution in applying these findings broadly.
Key findings
- Admission NIHSS score (OR = 1.317; 95% CI 1.097-1.669; P = .008)
- WMH severity (OR = 5.273; 95% CI 1.181-28.519; P = .037)
- Degree of ACA stenosis (OR = 7.223; 95% CI 1.631-38.985; P = .013)
- C-index of nomogram model was 0.852
- Area under the ROC curve was 0.867 (95% CI 0.811-0.906)
- Favorable outcome group (mRS 0-2, n = 56) vs poor outcome group (mRS 3-6, n = 24) showed significant differences in age, CRP level, WMH severity, and ACA stenosis (all P < .05)
Limitations
- Retrospective cohort design
- Small sample size (n=80)
- Potential confounding factors not controlled for
- Single-site study limits generalizability
- No long-term follow-up reported