Development and validation of a risk score (CHANGE) for cognitive impairment after ischemic stroke.
Development and validation of a risk score (CHANGE) for cognitive impairment after ischemic stroke.
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DOI：
10.1038/s41598-017-12755-z
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发表时间：
2017-09-29
影响因子：
4.6
通讯作者：
Kandiah N
中科院分区：
文献类型：
--
作者：
Chander RJ;Lam BYK;Lin X;Ng AYT;Wong APL;Mok VCT;Kandiah N
中风后认知障碍（PSCI）需要早期发现和管理。我们试图开发一种风险评分，用于在床旁筛查患者迟发性PSCI的风险。研究了卒中后3-6个月患有PSCI且无认知障碍（NCI）的缺血性卒中幸存者，以确定预测PSCI的候选变量。这些变量被用于使用回归模型开发风险评分。在来自新加坡和香港的三个独立队列中，对评分和最佳确定的临床临界点进行了开发、稳定性测试以及内部和外部验证。在1,088名受试者中，风险评分（称为CHANGE）在检测PSCI的显著风险时，受试者工作特征曲线下面积（AUROC）为0.74至0.82，并具有实际患病率的预测值。在卒中后3-6个月和12-18个月的验证数据中，低、中和高分受试者的PSCI患病率分别为7- 23%、25- 58%和67- 82%。CHANGE可有效筛查缺血性卒中幸存者卒中后18个月内发生PSCI的显著风险。CHANGE使用容易获得和可靠的临床数据，可能有助于识别PSCI的风险患者。
Post-stroke cognitive impairment (PSCI) warrants early detection and management. We sought to develop a risk score for screening patients at bedside for risk of delayed PSCI. Ischemic stroke survivors with PSCI and no cognitive impairments (NCI) 3–6 months post-stroke were studied to identify candidate variables predictive of PSCI. These variables were used to develop a risk score using regression models. The score, and the best identified clinical cutoff point, underwent development, stability testing, and internal and external validation in three independent cohorts from Singapore and Hong Kong. Across 1,088 subjects, the risk score, dubbed CHANGE, had areas under the receiver operating characteristics curve (AUROC) from 0.74 to 0.82 in detecting significant risk for PSCI, and had predicted values following actual prevalence. In validation data 3–6 and 12–18 months post-stroke, subjects with low, medium, and high scores had PSCI prevalence of 7–23%, 25–58%, and 67–82%. CHANGE was effective in screening ischemic stroke survivors for significant risk of developing PSCI up to 18 months post-stroke. CHANGE used readily available and reliable clinical data, and may be useful in identifying at-risk patients for PSCI.
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