Dataset Information

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

ABSTRACT:

Background

Three months is the standard timepoint for assessing final functional status after acute ischemic stroke in phase 3 clinical trials. Earlier reliable timepoints for outcome ascertainment would facilitate care quality improvement programs that employ administrative datasets and reduce the loss to follow-up observed in many stroke clinical trials. We assessed whether day 30 global disability status reliably predicts final 3-month disability outcome among acute stroke patients.

Methods

Data of 5,997 subjects in acute stroke trials conducted between 1998 and 2006 from the Virtual International Stroke Trials Archive dataset were partitioned into a derivation cohort (n = 4,051) and a validation cohort (n = 1,946). Global disability was assessed with modified Rankin Scale (mRS). To evaluate the association of day 30 vs day 90 mRS, weighted kappa agreement was computed and then adjusted using multivariable ordinal logistic modeling.

Results

Overall, mean age was 67.6 +/- 12.4 years; 2,541 (45.2%) were women. Day 30 mRS score correlated strongly with day 90 (r = 0.87, p < 0.001); weighted kappa agreement was 0.86 (95% confidence interval 0.85-0.87, p < 0.001). In multivariable logistic regression analysis, day 30 mRS was the dominant variable associated with day 90 mRS, accounting for 65.6% of the variance. Nine other baseline variables were associated with outcome, but collectively explained only an additional 1.8% of the variance.

Conclusions

After an index ischemic stroke, global disability status at 1 month reliably estimates final 3-month disability outcomes. One-month disability status alone may be dependable and efficient as an outcome measure in stroke quality improvement programs and select clinical trials.

SUBMITTER: Ovbiagele B

PROVIDER: S-EPMC2931650 | biostudies-literature | 2010 Aug

REPOSITORIES: biostudies-literature

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Publications

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

Ovbiagele Bruce B Lyden Patrick D PD Saver Jeffrey L JL

Neurology 20100801 8

<h4>Background</h4>Three months is the standard timepoint for assessing final functional status after acute ischemic stroke in phase 3 clinical trials. Earlier reliable timepoints for outcome ascertainment would facilitate care quality improvement programs that employ administrative datasets and reduce the loss to follow-up observed in many stroke clinical trials. We assessed whether day 30 global disability status reliably predicts final 3-month disability outcome among acute stroke patients.<h ...[more]

PMID: 20733143

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Project description:BACKGROUND:Early prediction of unfavorable outcome after ischemic stroke is of great significance to the clinical and therapeutic management. A nomogram is a better visual tool than earlier models and prognostic scores to predict clinical outcomes, which incorporates different factors to develop a graphic continuous scoring system and calculates accurately the risk probability of poor outcome entirely based on individual characteristics. However, to date, no nomogram models have been found to predict the probability of 6-month poor outcome after ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of the probability of 6-month unfavorable outcome in Chinese patients with ischemic stroke. METHODS:Based on the retrospective stroke registry, a single-center study which included 499 patients from May, 2013 to May, 2018 was conducted in Nanjing First Hospital (China) for ischemic stroke within 12?h of symptoms onset. The main outcome measure was 6-month unfavorable outcome (mRS?>?2). To generate the nomogram, NIHSS score on admission, Age, previous Diabetes mellitus and crEatinine (NADE) were integrated into the model. We assessed the discriminative performance by using the area under the curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. RESULTS:A visual NADE nomogram was constructed that NIHSS score on admission (OR: 1.190, 95%CI: 1.125-1.258), age (OR: 1.068, 95%CI: 1.045-1.090), previous diabetes mellitus (OR: 1.995, 95%CI: 1.236-3.221) and creatinine (OR: 1.010, 95%CI: 1.002-1.018) were found to be significant predictors of 6-month unfavorable outcome after acute ischemic stroke in Chinese patients. The AUC-ROC of nomogram was 0.791. Calibration was good (p?=?0.4982 for the Hosmer-Lemeshow test). CONCLUSION:The NADE is the first nomogram developed and validated in Chinese ischemic stroke patients to provide an individual, visual and precise prediction of the risk probability of 6-month unfavorable outcome.

Dataset Information

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

Background

Methods

Results

Conclusions

Publications

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

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