Predicting outcome after acute and subacute stroke - Development and validation of new prognostic models
Predicting outcome after acute and subacute stroke - Development and validation of new prognostic models
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DOI：
10.1161/hs0402.105909
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发表时间：
2002-04-01
期刊：
影响因子：
8.3
通讯作者：
Warlow, C
中科院分区：
文献类型：
--
作者：
Counsell, C;Dennis, M;Warlow, C
背景和目的：预测急性和亚急性卒中患者预后的统计模型有多种用途，但目前还没有合适的模型。因此，我们开发和验证了新的models. Methods回归模型，预测生存到30天后，中风和生存在一个非残疾状态在6个月内产生与使用既定的指南，对530例中风发病率的研究。为每个结果建立了三个模型，并在卒中发作后30天内收集了越来越详细的预测变量集。模型在外部验证，并在2个独立的中风患者队列中进行比较通过计算受试者工作特征曲线（AUC）下的面积和绘制校准图（538和1330名患者）来测量模型的平均值。（年龄、独居、中风前日常生活活动的独立性、格拉斯哥昏迷量表的语言成分、臂力，行走能力）通常与两个验证队列中更复杂的模型一样（AUC 0.84至0.88）。他们有很好的校准，但在预测独立概率最高的患者中过于乐观。在48小时内中风发作的患者之间的AUC没有差异，后来看到的;缺血性和出血性中风之间;和那些有和没有以前stroke. Conclusions简单的模型表现良好，足以用于流行病学的目的，如分层试验或校正的情况下混合。然而，临床医生应该谨慎使用这些模型，特别是在超急性卒中中，以影响个体患者的管理，直到他们得到进一步的评估。需要进一步的研究来测试来自大脑成像的额外信息是否可以提高预测的准确性。
Background and Purpose-Statistical models to predict the outcome of patients with acute and subacute stroke could have several uses, but no adequate models exist. We therefore developed and validated new models.Methods-Regression models to predict survival to 30 days after stroke and survival in a nondisabled state at 6 months were produced with the use of established guidelines on 530 patients from a stroke incidence study. Three models were produced for each outcome with progressively more detailed sets of predictor variables collected within 30 days of stroke onset. The models were externally validated and compared on 2 independent cohorts of stroke patients (538 and 1330 patients) by calculating the area under receiver operating characteristic curves (AUC) and by plotting calibration graphs.Results-Models that included only 6 simple variables (age, living alone, independence in activities of daily living before the stroke, the verbal component of the Glasgow Coma Scale, arm power, ability to walk) generally performed as well as more complex models in both validation cohorts (AUC 0.84 to 0.88). They had good calibration but were overoptimistic in patients with the highest predicted probabilities of being independent. There were no differences in AUCs between patients seen within 48 hours of stroke onset and those seen later; between ischemic and hemorrhagic strokes; and between those with and without a previous stroke.Conclusions-The simple models performed well enough to be used for epidemiological purposes such as stratification in trials or correction for case mix. However, clinicians should be cautious about using these models, especially in hyperacute stroke, to influence individual patient management until they have been further evaluated. Further research is required to test whether additional information from brain imaging improves predictive accuracy.