Association of multimodal computed tomography imaging and early modified Rankin Scale score with prognosis in patients with wake-up stroke and stroke while awake: an exploratory study.

Objective

To evaluate the prognostic value of multimodal computed tomography (CT) imaging and early modified Rankin Scale (mRS) score in patients with wake-up stroke (WUS) and stroke while awake (SWA).

Methods

This retrospective study included 108 patients with acute ischemic stroke, including 40 WUS and 68 SWA patients. All patients underwent multimodal CT imaging, including non-contrast CT, CT angiography, and CT perfusion. Early mRS was assessed within 24 hours after admission, and functional outcome was evaluated at 90 days. Firth penalized logistic regression was used to identify factors associated with poor functional outcome. Hierarchical models were constructed to evaluate the incremental value of early mRS and CTP-derived mismatch ratio beyond admission NIHSS. ROC analysis and nomogram construction were performed.

Results

Compared with SWA patients, WUS patients showed higher admission NIHSS scores, longer onset-to-admission intervals, and worse perfusion profiles, including lower CBF, higher MTT and TTP, and lower mismatch ratio (all P < 0.05). Early mRS and CTP-derived mismatch ratio were independently associated with poor 90-day functional outcome in the Firth logistic regression model. The final model showed good discrimination (AUC = 0.964, 95% CI: 0.929-0.999). Adding early mRS significantly improved discrimination beyond admission NIHSS (AUC: 0.612 vs. 0.925, P < 0.001), and further addition of mismatch ratio provided additional improvement (AUC: 0.925 vs. 0.964, P = 0.041).

Conclusion

Early mRS provides substantial prognostic information beyond admission NIHSS, and CTP-derived mismatch ratio offers additional value for 90-day functional outcome assessment. The combined model may assist individualized risk stratification in patients with WUS and SWA.