Predicting long-term outcome after acute ischemic stroke - A simple index works in patients from controlled clinical trials
Predicting long-term outcome after acute ischemic stroke - A simple index works in patients from controlled clinical trials
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DOI：
10.1161/strokeaha.107.505867
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发表时间：
2008-06-01
期刊：
影响因子：
8.3
通讯作者：
Weimar, Christian
中科院分区：
文献类型：
--
作者：
Koenig, Inke R.;Ziegler, Andreas;Weimar, Christian
背景和目的：脑卒中患者康复的早期可靠预后对于开始个体化治疗以及告知患者和亲属非常重要。我们最近开发并验证了预测急性中风后3个月内生存和功能独立性的模型，该模型基于年龄和中风后6小时内评估的美国国立卫生研究院中风量表评分。在此，我们证明了我们的模型在来自对照临床试验的独立患者样本中的适用性。方法-预后模型用于预测来自虚拟国际卒中试验档案（VISTA）的5419例患者的生存和功能恢复。此外，我们试图通过自适应截距和估计新的模型参数来提高精度。结果：原始模型对患者的生存率和功能恢复率分别为70.4%和72.9%。由于在对照试验中对患者的预测略显悲观，采用截距将准确性提高到74.8%（生存率）和74.0%（功能恢复）。然而，新的参数估计没有产生相关的进一步改进。结论：对于纳入对照试验的急性缺血性卒中患者，我们基于年龄和美国国立卫生研究院卒中量表评分的易于应用的预后模型正确预测了3个月后的生存和功能恢复。此外，简单的调整有助于调整不同的预后，如果有大量可用的数据集，建议进行调整。
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.