Eareddy Dheemanth Kumar

Neumed Clinics,
India

Abstract Title: Analysis of WORSEN Score for Predicting the Deterioration of Acute Ischemic Stroke

Biography:

Dr. Eareddy Dheemanth Kumar is a board-certified neurologist with expertise in the management of acute ischemic stroke and predictive scoring systems. He completed his DrNB in Neurology and has worked at Kamineni Hospital, Hyderabad, where he led research on early neurological deterioration in stroke patients. Dr. Dheemanth's academic interests include stroke prediction models, neuroimaging, and improving patient outcomes through early detection and intervention. He is committed to advancing stroke care through evidence-based practices and public health education.

Research Interest:

Background: Early neurological deterioration (END) in acute ischemic stroke (AIS) is associated with poor prognosis, increased morbidity, and mortality. Predicting END is crucial for timely intervention and improving patient outcomes. The WORSEN score, a predictive tool, assesses the risk of deterioration in stroke patients. This study evaluates the utility of the WORSEN score in predicting END in AIS patients and identifies key predictors associated with deterioration. Methods: This retrospective study was conducted at Kamineni Hospital, Hyderabad, from January 2022 to December 2022. A total of 159 patients with AIS, admitted within 2 days of symptom onset, were included. The WORSEN score was calculated upon admission, and patients were monitored for END, defined as a worsening of the National Institutes of Health Stroke Scale (NIHSS) score by ≥4 points within one week. Additional clinical factors, including age, gender, comorbidities (hypertension, diabetes, myocardial infarction), laboratory markers (HbA1C, LDL), and radiological findings, were analyzed to assess their association with END. Results: END occurred in 32 (20.1%) of the 159 patients. The mean age of patients with END was 57.91 years, compared to 59.71 years for those without END. Among those with END, 56.3% were male, 87.5% had hypertension, and 65.6% had diabetes. In patients without END, 71.7% were male, 76.4% had hypertension, and 48.8% had diabetes. A higher percentage of patients with END had a history of myocardial infarction (31.2%) compared to those without END (10.5%). The mean NIHSS score at admission was 12.50 for patients with END and 6.23 for those without. Similarly, the mean Glasgow Coma Scale (GCS) at admission was lower in the END group (13.47) compared to the non-END group (14.73). Infarct size, higher HbA1C levels (mean 8.87 vs. 7.24), and higher LDL levels (mean 132.72 mg/dl vs. 109.94 mg/dl) were significantly associated with END. The WORSEN score demonstrated an area under the curve (AUC) of 0.97, with an optimal cutoff score of 4. At this threshold, the sensitivity was 93.8%, specificity 92.9%, positive predictive value (PPV) 76.9%, and negative predictive value (NPV) 98.3%. The study confirmed that higher WORSEN scores were associated with a higher likelihood of developing END, increased mortality, and worse outcomes. Conclusion: The WORSEN score is a highly reliable tool for predicting early neurological deterioration in acute ischemic stroke. It helps identify patients at high risk for deterioration, enabling timely intervention and closer monitoring in intensive care or stroke units. The study highlights the importance of clinical factors such as comorbidities, initial NIHSS score, and infarct size in predicting END. Early recognition of these risk factors can guide therapeutic decisions, including aggressive monitoring and appropriate treatment strategies, potentially improving patient outcomes. Recommendations: Monitoring: Patients with high WORSEN scores should be closely monitored in intensive care units or stroke units, even if their initial NIHSS scores are low. Interventions: Early management of hypertension, hyperglycemia, and dyslipidemia, as well as prompt antithrombotic treatment, may reduce the risk of deterioration. Public Health: Public health campaigns aimed at reducing smoking, alcohol consumption, and unhealthy diets can reduce the incidence of stroke and its complications. Further Research: Larger, multicenter studies are needed to validate these findings and refine the WORSEN score’s predictive value across diverse patient populations.