Predicting Long-Term Outcome After Acute Ischemic Stroke

Abstract

Background and Purpose-An early and reliable prognosis for recovery in stroke patients is important for initiation of individual treatment and for informing patients and relatives. We recently developed and validated models for predicting survival and functional independence within 3 months after acute stroke, based on age and the National Institutes of Health Stroke Scale score assessed within 6 hours after stroke. Herein we demonstrate the applicability of our models in an independent sample of patients from controlled clinical trials. Methods-The prognostic models were used to predict survival and functional recovery in 5419 patients from the Virtual International Stroke Trials Archive (VISTA). Furthermore, we tried to improve the accuracy by adapting intercepts and estimating new model parameters. Results-The original models were able to correctly classify 70.4% (survival) and 72.9% (functional recovery) of patients.Because the prediction was slightly pessimistic for patients in the controlled trials, adapting the intercept improved the accuracy to 74.8% (survival) and 74.0% (functional recovery). Novel estimation of parameters, however, yielded no relevant further improvement. Conclusions-For acute ischemic stroke patients included in controlled trials, our easy-to-apply prognostic models based on age and National Institutes of Health Stroke Scale score correctly predicted survival and functional recovery after 3 months. Furthermore, a simple adaptation helps to adjust for a different prognosis and is recommended if a large data set is available.

Copeptin adds prognostic information after ischemic stroke

“…Despite the modest size of the AUC increases, copeptin improved risk classification by 11.8% for functional outcome and by 37.2% for mortality compared to the validated prognostic index by König IR et al, encompassing NIHSS and age. 19 Moreover, copeptin improved reclassification compared to the multivariate models including demographic factors, cardiovascular risk factors, lesion size in MR, comorbidities, and admission laboratory variables such as CRP and glucose. The CoRisk study confirms and extends the conclusions of the previously published derivation study 3 .…”

“…As reference for reclassification, we chose the prognostic index of König IR et al because of its validation for both functional outcome and mortality at 3 months along with its robust prognostic power arising from two easily accessible variables such as age and NIHSS. 19 In order to be used in clinical routine, prognosis should be almost immediate and based only on a few variables, thus copeptin, which adds to the simple and highly accurate prognostic index by Koenig et al 19 may help physicians to more accurately inform patients and care givers upon the overall prognosis. Copeptin might help in early decision making on aggressiveness of care, potential new interventions, discharge planning and rehabilitation.…”

Acute blood pressure levels and long‐term outcome in ischemic stroke

“…The severity of the stroke was defined at the ward using the National Institutes of Health Stroke Scale (NIHSS) by specially trained personnel (Brott et al., 1989; Konig et al., 2008). Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) (Adams et al., 1993).…”

Good clinical outcome after ischemic stroke with successful revascularization is time-dependent

“…3,[21][22][23][24][25][26] Logistic regression was used for multivariable modeling, with stepwise methodology used for variable selection. Goodness of fit was assessed via the Hosmer and Lemeshow test.…”