ArticleNeurology and therapy2026
Prognostic Value of the Day 5-7 Neurological Examination in Anterior Circulation Ischemic Stroke: A Post Hoc Analysis of the MARVEL Trial.
Article in Neurology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
28 authors.
Funding
Abstract
introductionEarly prediction of long-term recovery after endovascular thrombectomy (EVT) is essential for guiding care but is often confounded by the instability of acute neurological assessments. We aimed to evaluate the prognostic value of the National Institutes of Health Stroke Scale (NIHSS) measured at day 5-7 or earlier if discharged (D5-7/discharge) compared with baseline NIHSS and change-based metrics for predicting 90-day functional outcomes.
methodsWe performed a post hoc analysis of the MARVEL trial, a multicenter randomized clinical trial involving adult patients with acute ischemic stroke due to anterior circulation large-vessel occlusion. The prognostic performance of baseline NIHSS, D5-7/discharge NIHSS, absolute change (ΔNIHSS), and percentage change was evaluated. The primary outcome was favorable outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days. Discriminative performance was assessed using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
resultsAmong 1650 included patients, the D5-7/discharge NIHSS showed the highest discriminative ability among the evaluated NIHSS-based measures for predicting favorable outcome (AUC 0.897; 95% confidence interval [CI] 0.881-0.912), exceeding percentage change (AUC 0.891), ΔNIHSS (AUC 0.866), and baseline NIHSS (AUC 0.650) (all p < 0.001). A pragmatic, restricted cubic spline-informed threshold of D5-7/discharge NIHSS ≤ 5 yielded a sensitivity of 64.7% and specificity of 93.3% for 90-day favorable outcome. Adding D5-7/discharge to a model containing traditional covariates significantly improved predictive accuracy (AUC increased from 0.782 to 0.910; NRI 0.437; p < 0.001). Percentage change in NIHSS offered better discrimination than absolute change.
conclusionThe NIHSS assessed at D5-7/discharge showed higher discriminative performance for 90-day functional outcomes than baseline and change-based measures in this post hoc analysis. A threshold of ≤ 5 provided high specificity and may aid bedside counseling and discharge planning, although external validation is warranted.
trial registrationChiCTR.org.cn Identifier, ChiCTR2100051729.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.