Prognostic indices for early mortality in ischaemic stroke - meta-analysis

Abstract

Objectives: Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. Methods:We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003-2014) used in predicting early mortality (< 6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic (AUC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways, and missing data. Results:We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for metaanalysis. Most studies were either retrospective, or posthoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82 -0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE. -these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78-0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72-0.72) ) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84 -0.87). Conclusions:Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base.

Validating and comparing stroke prognosis scales

“…DISCUSSION Validation and quantitative comparison can assist in choice of prognostic scale, yet there have been few articles offering such analyses in stroke. [3][4][5] We provide these data for recognized acute stroke prognostic scales, with ASTRAL showing superior prognostic utility and SPI2 the lowest prognostic accuracy.…”

“…2 Numerous scales purport to predict acute stroke outcomes from baseline features. [3][4][5] In general, these prognosis scales have had limited traction and have not been incorporated into routine clinical practice or guidelines. 3 There are various plausible reasons why these scales have not been adopted by the stroke community.…”

Clinical prediction models for mortality and functional outcome following ischemic stroke: A systematic review and meta-analysis

“…For the first time, the network of the publications for each model are consolidated and evaluated collectively. To our knowledge this is the first review of pms for tertiary prevention in stroke that has accounted for the newly recommended guidelines in prediction and is a comprehensive update of the previous systematic reviews and meta-analyses[ 40 , 41 ]. Arguably, this review is limited by the decision not to contact authors for unreported data.…”

Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men

“…While several relevant mortality prediction tools are available for clinical practice, they have been developed mainly for assessment in the elderly,8 9 make only short-term (6-month) mortality predictions10 11 or have been developed for specific high-risk populations 12–17. Although methods to update existing clinical prediction algorithms have been proposed,18 predictors used in existing models may not be available in datasets from other populations, particularly when, as in this case, use of self-reported health variables that can be easily obtained without physical examination would be desirable.…”