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CC BY-NC-ND 4.0 · Thromb Haemost
DOI: 10.1055/a-2666-6277
New Technologies, Diagnostic Tools and Drugs

ANGWC Nomogram for Predicting Poor 3-month Outcome after Intravenous Thrombolysis in Young and Middle-aged Patients with First-ever Stroke

Shuang-Yin Lei   *
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Yu-Qian Yang   *
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Yang Qu
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Reziya Abuduxukuer
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Zi-Han Song
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Jia-Cheng Liu
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Jia-Xin Ren
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Peng Zhang
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Hang Jin
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Yi Yang 
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
,
Zhen-Ni Guo
1   Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, China
2   Department of Neurology, Neuroscience Research Center, the First Hospital of Jilin University, Changchun, China
› Author Affiliations
Funding This work was supported by the National Natural Science Foundation of China (U24A20686), Science and Technology Department of Jilin Province (YDZJ202302CXJD061, 20220303002SF), and Jilin Provincial Key Laboratory (YDZJ202302CXJD017) to Y.Y., the Talent Reserve Program of the First Hospital of Jilin University (JDYYCB-2023002) to Z.G., and the Graduate Innovation Fund of Jilin University (2025CX292) to S.L.
› Further Information
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Abstract

Background

The rising prevalence of ischemic stroke among younger individuals is concerning. Despite the significant benefits of intravenous thrombolytic therapy for young and middle-aged patients, the disease burden in this demographic is often overshadowed by that of older patient groups. This study aims to identify the risk factors for poor 3-month outcomes following intravenous thrombolysis in young and middle-aged patients with first-ever stroke and to develop a novel nomogram.

Methods

This prospective study included patients aged 18 to 59 years with a first ischemic stroke from 16 hospitals. Patients from one of the hospitals were designated as the training cohort. General information and clinical data were compared between the favorable outcome (modified Rankin Scale [mRS] score < 2) and the poor outcome groups (mRS score ≥ 2). Logistic regression analysis was used to develop the nomogram. An additional 113 patients from the other 15 hospitals were recruited as the validation cohort.

Results

A total of 217 patients were enrolled in the training cohort, with 47% experiencing poor 3-month outcomes. Five variables were selected to construct the ANGWC (Age, NIHSS score, blood Glucose, White blood cell count, and total Cholesterol) nomogram. The AUC of the nomogram was 0.802 in the training cohort and 0.747 in the validation cohort. The Hosmer–Lemeshow goodness-of-fit test showed a P-value > 0.05, and calibration curve slopes were close to 1. Decision curve analysis indicated good clinical utility.

Conclusion

The ANGWC nomogram provides a reliable prediction of poor 3-month outcomes after intravenous thrombolysis in young and middle-aged patients with first-ever stroke.

Keywords

ischemic stroke - intravenous thrombolysis - young and middle-aged - nomogram - predictive model

Data Availability Statement

Data will be made available from the corresponding author upon reasonable request.


Authors' Contribution

Z.G., Y.Y., H.J., and S.L. conceived this study. Y.Q. and R.A. collected data. J.R. and P.Z. provided research materials and methods. S.L. and Y.Q. analyzed the data. S.L., Y.-Q.Y., Z.S., and J.L. drafted the manuscript. All authors of the manuscript have reviewed and approved the final version of the manuscript.


* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 07 February 2025

Accepted: 18 July 2025

Article published online:
11 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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