Predicting cerebral edema in ischemic stroke patients

Objectives: To produce a scoring system for predicting the development of edema in ischemic stroke patients without edema on admission. Methods: This retrospective study included 572 ischemic stroke patients (73.3 ± 13.0 years, 300 male) without signs of cerebral edema on the first CT scan, which was performed on admission. Another scan was normally performed 3 days later, and subsequently whenever needed. Edema was defined as cerebral hypodensity with compression of lateral ventricles. The main clinical, laboratory, and instrumental variables obtained during the first 24 h were related to the appearance of edema on the CT scans performed after the first one. Results: Cerebral edema occurred in 158 patients (27.6%) after a median time of 4 days. The variables independently associated with edema development were (odds ratio, 95% CI) the following: (1) total anterior circulation syndrome (4.20, 2.55–6.93; P < 0.0001), (2) hyperdense appearance of middle cerebral artery (4.12, 2.03–8.36; P = 0.0001), (3) closed eyes (2.53, 1.39–4.60; P = 0.002), (4) vomiting (3.53, 1.45–8.60; P = 0.006), (5) lacunar cerebral syndrome (0.36, 0.17–0.77; P = 0.008); and (6) white matter lesions (0.53, 0.33–0.86; P = 0.01). Counting one positive point for the first four variables and one negative point for the last two variables, a scoring system (E-score) was built. Cerebral edema could be predicted when the score was ≥ 1 (positive predictive value 61.6%, specificity 85.3%, sensitivity 62.0%). The area under the receiver operating characteristic curve was 0.78. Conclusions: In ischemic stroke patients, six variables obtained during the first 24 h of hospitalization were predictive of subsequent cerebral edema development.