# Prognostic value of the modified clot burden score in predicting outcomes of acute ischemic stroke patients

## TL;DR

This study shows that a modified version of the Clot Burden Score better predicts outcomes in acute ischemic stroke patients compared to the original score.

## Contribution

The modified Clot Burden Score (mCBS) is shown to have improved prognostic accuracy over the original CBS in predicting stroke outcomes.

## Key findings

- mCBS showed stronger correlations with NIHSS and mRS90 than the original CBS.
- mCBS had higher AUC for predicting disability and severity compared to CBS.
- mCBS and CBS showed similar AUC for predicting mortality, with no significant difference.

## Abstract

Acute stroke is one of the leading causes of mortality and disability worldwide. In recent years, various scoring systems have been introduced to predict the outcomes of acute stroke patients, one of which is the Clot Burden Score (CBS). Therefore, the present study evaluates the prognostic value of the modified CBS in patients presenting with acute ischemic stroke.

This study was conducted from 2022 to 2024 at Ghaem Hospital, Mashhad. Patients presenting to the hospital’s emergency department with symptoms of acute ischemic stroke were identified based on NIHSS clinical examination. NIHSS was assessed at admission, ASPECTS on baseline imaging, and the modified Rankin Scale at admission (mRS0) and 90 days post-stroke (mRS90). CBS, DWI-ASPECTS, mRS, and the modified CBS were measured for each patient. The collected data were analyzed using SPSS statistical software, and the prognostic value of both the original and modified CBS was assessed for predicting different outcomes, including mortality, disability, and severe disease.

A total of 130 patients were included (mean age 64.9 ± 14.1 years; 53.1% male). Compared to CBS, mCBS showed stronger correlations with NIHSS (ρ=–0.569, p < 0.0001) and mRS90 (ρ=–0.568, p < 0.0001). For disability prediction (mRS90 ≥ 2), the AUC of mCBS was 0.807 versus 0.735 for CBS (p = 0.0019). For severity (NIHSS ≥ 15), the AUC was 0.778 versus 0.720 (p = 0.0156). For mortality, AUCs were 0.708 and 0.681, respectively, with no significant difference (p = 0.3821).

Based on the findings of this study, the modified CBS has greater prognostic value than the original CBS for predicting outcomes in acute stroke patients. If confirmed by future studies, the modified CBS may be considered a potential replacement for the conventional CBS scoring system.

The online version contains supplementary material available at 10.1186/s12883-026-04626-w.