Evaluation of combining Alberta Stroke Program Early CT Score (ASPECTS) with mean platelet volume, plateletcrit, and platelet count in predicting short- and long-term prognosis of patients with acute ischemic stroke

Background: There is controversy regarding Alberta Stroke Program Early CT Score (ASPECTS) and platelet indices as predictors of outcome in patients with acute ischemic stroke (AIS). We aimed to assess the prognostic value of ASPECTS, mean platelet volume (MPV), plateletcrit (PCT), and platelet count (Plt) in 3-month and 1year functional outcomes of AIS patients, both independently and in combination. Methods: This prospective study was conducted in Shams Al-shomuos and Ghaem hospitals of Mashhad, Iran from June 2019 to January 2021. Overall, 553 patients above 18 years old with first-ever anterior circulation AIS met the eligibility criteria and were included. Clinical, hematologic, radiologic, and demographic data of patients were recorded at baseline. The 3-month and 1-year functional outcome was evaluated by modified Rankin Scale (mRS). Multivariate logistic regression was used to determine the independent predictors of poor functional outcome (mRS > 2) and mortality. Results: The mean age of the patients was 65.50 +/- 14.41 years and 282 patients (51%) were male. ASPECTS < 7 was an independent predictor of both poor function (OR = 1.94, 95%CI = 1.04-3.62, P = 0.04) and mortality (OR = 2.02, 95%CI = 1.14-3.58, P = 0.02) at 1 year. MPV was also a strong predictor of 3-month (OR = 3.88, 95%CI = 2.04-7.38, P = 0.02) and 1-year (OR = 3.32, 95%CI = 1.91-5.78, P = 0.01) mortality, as well as 3month (OR = 3.25, 95%CI = 1.80-5.86, P < 0.001) and 1-year (OR = 4.35, 95%CI = 2.36-8.02, P < 0.001) poor function. For 1-year poor function (OR = 9.33, 95%CI = 2.19-39.73, P = 0.003) and mortality (OR = 6.40, 95% CI = 2.09-19.64, P = 0.001), ASPECTS combined with all platelet indices found to be a more robust independent predictor compared to each variable alone. Conclusion: Although MPV is an independent predictor of both 3-month and 1-year poor function and mortality in AIS patients, ASPECTS < 7 was found to be a risk factor for 1-year poor function and mortality. Moreover, the prognostic value of both platelet indices and ASPECTS are greater when they are combined together in AIS patients.