Age and National Institutes of Health Stroke Scale Score Within 6 Hours After Onset Are Accurate Predictors of Outcome After Cerebral Ischemia

Abstract

on behalf of the German Stroke Study CollaborationBackground and Purpose-To date, no validated, comprehensive, and practicable model exists to predict functional recovery within the first hours of cerebral ischemic symptoms. The purpose of this study was to externally validate 2 prognostic models predicting functional outcome and survival at 100 days within the first 6 hours after onset of acute cerebral ischemia. Methods-On admission to a participating hospital, patients were registered prospectively and included according to defined criteria. Follow-up was performed 100 days after the event. With the use of prospectively collected data, 2 prognostic models were developed and internally calibrated in 1079 patients and externally validated in 1307 patients. By means of age and National Institutes of Health Stroke Scale (NIHSS) score as independent variables, model I predicts incomplete functional recovery (Barthel Index Ͻ95) versus complete functional recovery, and model II predicts mortality versus survival. Results-In the validation data set, model I correctly predicted 62.9% of the patients who were incompletely restituted or had died and 83.2% of the completely restituted patients, and model II correctly predicted 57.9% of the patients who had died and 91.5% of the surviving patients. Both models performed better than the treating physicians' predictions made within 6 hours after admission. Conclusions-The resulting prognostic models are useful to correctly stratify treatment groups in clinical trials and should guide inclusion criteria in clinical trials, which in turn increases the power to detect clinically relevant differences.

Monocyte Subtypes Predict Clinical Course and Prognosis in Human Stroke

“…Correlations were calculated with parametric and nonparametric coefficients. Early clinical worsening, SAI, outcome, mortality and infarct volume at follow up were dependent variables assessed in logistic or linear regression models, assessing the effect of monocyte subtypes at admission after adjusting for age and baseline stroke severity, which are strong, accurate and validated independent outcome predictors (Weimar et al, 2004). All tests were performed using the SPSS software version 14.0 Figure 1 Quantification of monocyte subsets.…”

The Immune System in Stroke: Clinical Challenges and Their Translation to Experimental Research

“…Age, sex and comorbidities influence outcome following stroke and are themselves important contributors to inflammatory responses to cerebral ischemia. Advancing age and stroke severity are powerful predictors of functional outcome and survival following ischemic stroke (Weimar et al 2004;Andersen et al 2011). Women have a higher case fatality than men, and women survivors have worse outcomes (Di Carlo et al 2003;Appelros et al 2009).…”

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

“…The NIHSS is a validated, 15-item scale that is used to assess key components of the standard neurologic examination in stroke patients [21][22][23][24]. The scale assesses level of consciousness, ocular motility, facial and limb strength, sensory function, coordination, language, speech, and attention.…”

“…Scores between 0 and 5 are generally classified as mild, and scores exceeding 15 are generally classified as severe. The NIHSS predicts short-and long-term neurologic outcomes and can be reliably abstracted from the medical record [22,23,25].…”