Stroke Severity Is a Crucial Predictor of Outcome: An International Prospective Validation Study.
Stroke Severity Is a Crucial Predictor of Outcome: An International Prospective Validation Study.
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DOI：
10.1161/jaha.115.002433
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发表时间：
2016-01-21
影响因子：
5.4
通讯作者：
Global Comparators Stroke GOAL collaborators
中科院分区：
文献类型：
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作者：
Rost NS;Bottle A;Lee JM;Randall M;Middleton S;Shaw L;Thijs V;Rinkel GJ;Hemmen TM;Global Comparators Stroke GOAL collaborators
中风是世界范围内发病率和死亡率的主要原因之一。如果没有可靠的预测模型和结果测量，就不可能对护理系统进行比较。我们分析了从4个国家收集的前瞻性数据，以探索卒中严重程度在预后预测中的重要性。在2个月的时间里，来自参与全球比较者卒中目标(全球结果加速学习)合作的医院的所有急性缺血性中风患者在入院时都获得了国立卫生研究院卒中量表(NIHSS)的评分，并在30天和90天获得了修正的Rankin量表评分。这些数据被添加到管理数据集中，并得出了包括年龄、性别、共病指数和NIHSS在内的风险预测模型，包括7天内的住院死亡、所有的住院死亡以及30天和90天的死亡和良好结局。使用解释变量的比例来评估每个变量的相对重要性。在1034例急性缺血性卒中住院患者中，614例有全套NIHSS和两种修改后的Rankin量表记录；在这些患者中，507名患者可能与管理数据有关。共病指数解释变异的边际比例为0.7%~4.0%，NIHSS评分解释变异的边际比例为11.3~25.0。模型解释的百分比因结果而异(16.6-29.1%)，好结果的百分比在30天和90天时最高。在30天和90天的改良兰金量表评分之间有很高的一致性(加权κ=0.82)。在这项前瞻性的先导性研究中，基线NIHSS评分对于预测急性缺血性卒中的预后至关重要，其次是年龄；而传统的共病指数对整个模型的贡献很小。未来对不同护理系统之间的卒中结果的研究将受益于纳入基线NIHSS评分。
Stroke is among the leading causes of morbidity and mortality worldwide. Without reliable prediction models and outcome measurements, comparison of care systems is impossible. We analyzed prospectively collected data from 4 countries to explore the importance of stroke severity in outcome prediction. For 2 months, all acute ischemic stroke patients from the hospitals participating in the Global Comparators Stroke GOAL (Global Outcomes Accelerated Learning) collaboration received a National Institutes of Health Stroke Scale (NIHSS) score on admission and a modified Rankin Scale score at 30 and 90 days. These data were added to the administrative data set, and risk prediction models including age, sex, comorbidity index, and NIHSS were derived for in‐hospital death within 7 days, all in‐hospital death, and death and good outcome at 30 and 90 days. The relative importance of each variable was assessed using the proportion of explained variation. Of 1034 admissions for acute ischemic stroke, 614 had a full set of NIHSS and both modified Rankin Scale values recorded; of these, 507 patients could be linked to administrative data. The marginal proportion of explained variation was 0.7% to 4.0% for comorbidity index, and 11.3 to 25.0 for NIHSS score. The percentage explained by the model varied by outcome (16.6–29.1%) and was highest for good outcome at 30 and 90 days. There was high agreement between 30‐ and 90‐day modified Rankin Scale scores (weighted κ=0.82). In this prospective pilot study, the baseline NIHSS score was essential for prediction of acute ischemic stroke outcomes, followed by age; whereas traditional comorbidity index contributed little to the overall model. Future studies of stroke outcomes between different care systems will benefit from including a baseline NIHSS score.