Abstract Details

This was a single-centre, retrospective study, consisting of 852 consecutive patients admitted to Queen Mary Hospital for acute ischemic stroke from August 2018-December 2020. All patients received a CT brain, whilst 70.1% had an MRI brain. We determined the risk associations of individual components of SeLECT (Severity, Large-artery atherosclerosis, Early seizures (≤7 days post-stroke), Cortical, Middle cerebral artery (MCA) Territory) with PSE, and further included new parameters including infarct size and haemorrhagic transformation (HT). Predictive values were illustrated by calculating area-under-curve (AUC) of receiver operating characteristic (ROC) curves. 

At median follow-up of 893 days, PSE occurred in 5.3% of patients (mean time-to-first seizure: 311.2±367.0 days). Severe stroke (NIHSS ≥11), MCA territory involvement, cortical involvement, and large infarct size (≥5cm or ≥1/3 of MCA territory) were associated with PSE. 

Multivariate regression further showed that HT of any severity was independently associated with PSE (sHR 4.72, 95% CI 2.36-9.41, p<0.001). “H-SeLECT” was obtained by adding 2 marks to SeLECT for presence of any HT, which was calculated by dividing its sub-distribution hazard ratio (6.99) with the median of the lowest three values (3.43) in univariate analysis and rounding to the nearest integer. The AUC of ROC curve of H-SeLECT was significantly increased when compared with SeLECT using Z test (0.813 vs. 0.774, Z=2.67; p=0.008).