PREDICTION OF LONG-TERM OUTCOME IN THE EARLY HOURS FOLLOWING ACUTE ISCHEMIC STROKE
PREDICTION OF LONG-TERM OUTCOME IN THE EARLY HOURS FOLLOWING ACUTE ISCHEMIC STROKE
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DOI：
10.1001/archneur.1995.00540270038017
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发表时间：
1995-03-01
影响因子：
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通讯作者：
FIESCHI, C
中科院分区：
文献类型：
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作者：
FIORELLI, M;ALPEROVITCH, A;FIESCHI, C
目的：根据快速床边检查中获得的临床结果，开发预测缺血性中风发病后最初几个小时内的结果的模型。设计：从随机多中心试验的数据库中检索临床记录。由此产生的病例系列分为两个亚组，分别作为“训练集”和“测试集”。对训练集应用逻辑回归，以在基线临床结果中选择预后预测因子，然后在测试集中验证基于独立预后预测因子的模型的性能。设置：参与意大利急性中风研究的 11 家初级保健机构（医院或大学诊所），研究血液稀释和血液稀释的疗效。单唾液酸神经节苷脂治疗急性缺血性中风。患者：首次幕上缺血性中风发作后 6 小时内观察到的连续非昏迷患者 (N=300)。主要结果指标：中风后 4 个月死亡或残疾，残疾定义为 Rankin 量表得分为 3 或更高。结果：年龄和 CNS 评分定义了 6 个风险组，预测 4 个月不良结果率范围为10%（70 岁或以下且初始 CNS 评分为 7 或更高的患者）至 89%（70 岁以上且 CNS 评分为 4.5 或更低的患者）。当以 60% 的不良结局风险为截止值时，训练集的预测准确度为 78%+/-6%，测试集的预测准确度为 72%+/-9%。 结论：通过基于年龄和 CNS 评分的简单模型，可以在急性缺血性中风后的最初几个小时内预测长期结局。
Objective: To develop a model for predicting outcome in the first few hours after the onset of an ischemic stroke on the basis of the clinical findings obtained during a rapid bedside examination.Design: Clinical records were retrieved from the data bank of a randomized multicenter trial. The resulting case series was split into two subgroups that served as a ''training set'' and a ''test set.'' Logistic regression was applied to the training set to select the prognostic predictors among baseline clinical findings, The performances of the model based on independent prognostic predictors were then validated in the test set.Setting: Eleven primary care institutions (either hospitals or university clinics) participating in the Italian Acute Stroke Study on the efficacy of hemodilution and monosialoganglioside in acute ischemic stroke.Patients: Consecutive noncomatose patients (N=300) observed within the first 6 hours after the onset of a first supratentorial ischemic stroke.Main Outcome Measure: Death or disablement 4 months after the index stroke, Disablement was defined as a score of 3 or higher on the Rankin Scale.Results: Age and CNS score defined six risk groups with a predicted 4-month poor outcome rate ranging from 10% (patients aged 70 years or younger and with an initial CNS score of 7 or higher) to 89% (patients older than 70 years and with a CNS score of 4.5 or lower). When a risk of poor outcome of 60% was taken as a cutoff, the accuracy of the prediction was 78%+/-6% in the training set and 72%+/-9% in the test set.Conclusion: Long-term outcome can be predicted in the first few hours following an acute ischemic stroke by means of a simple model based on age and CNS score.