Predicting functional outcome and survival after acute ischemic stroke.
OBJECTIVE
Disability and mortality represent the most relevant clinical outcome after acute ischemic stroke. However, validated and comprehensive prognostic models for recovery have not been developed. An accurate model including all previously suggested independent outcome predictors could improve the design and analysis of clinical trials. We therefore developed prognostic models for functional dependence and death after 100 days in a large cohort of stroke patients.


METHODS
From the German Stroke Database, 1754 prospectively collected records of patients with acute ischemic stroke were used for the development of prognostic models. Intubated patients and patients with low functional status before stroke were excluded. Functional independence was defined as a Barthel Index >/=95 after 100 days. Prognostic factors assessable within 72 hours after admission were identified by a systematic literature review. The final models of binary logistic regression analyses were internally validated and calibrated.


RESULTS
The resulting cross-validated and calibrated models correctly classified more than 80 % of the patients and yielded the following prognostic factors for functional independence: Age, right and left arm paresis at admission, NIH-Stroke Scale at admission, Rankin Scale 48-72 hours later, gender, prior stroke, diabetes, fever, lenticulostriate infarction, neurological complications. The following variables were identified as prognostic factors for death: Age, NIH-Stroke Scale at admission, and fever.


CONCLUSIONS
Our work gives an important insight into prognostic factors after acute ischemic stroke and presents predictive models with high prognostic accuracy. Together with a prospective validation study, currently underway, we hence hope to improve the prediction of functional outcome after ischemic stroke.
Weimar
Christian
C
Department of Neurology, University of Essen, Hufelandstr. 55, Germany. stroke.med@uni-essen.de
Ziegler
Andreas
A
König
Inke R
IR
Diener
Hans-Christoph
HC
D000203:Activities of Daily Living; D000208:Acute Disease; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000534:rehabilitation*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016019:Survival Analysis