Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race.
OBJECTIVE
We sought to build models that address questions of interest to patients and families by predicting short- and long-term mortality and functional outcome after ischemic stroke, while allowing for risk restratification as comorbid events accumulate.


METHODS
A cohort of 451 ischemic stroke subjects in 1999 were interviewed during hospitalization, at 3 months, and at approximately 4 years. Medical records from the acute hospitalization were abstracted. All hospitalizations for 3 months poststroke were reviewed to ascertain medical and psychiatric comorbidities, which were categorized for analysis. Multivariable models were derived to predict mortality and functional outcome (modified Rankin Scale) at 3 months and 4 years. Comorbidities were included as modifiers of the 3-month models, and included in 4-year predictions.


RESULTS
Poststroke medical and psychiatric comorbidities significantly increased short-term poststroke mortality and morbidity. Severe periventricular white matter disease (PVWMD) was significantly associated with poor functional outcome at 3 months, independent of other factors, such as diabetes and age; inclusion of this imaging variable eliminated other traditional risk factors often found in stroke outcomes models. Outcome at 3 months was a significant predictor of long-term mortality and functional outcome. Black race was a predictor of 4-year mortality.


CONCLUSIONS
We propose that predictive models for stroke outcome, as well as analysis of clinical trials, should include adjustment for comorbid conditions. The effects of PVWMD on short-term functional outcomes and black race on long-term mortality are findings that require confirmation.
Kissela
Brett
B
Department of Neurology, University of Cincinnati, Ohio, USA. Brett.kissela@uc.edu
Lindsell
Christopher J
CJ
Kleindorfer
Dawn
D
Alwell
Kathleen
K
Moomaw
Charles J
CJ
Woo
Daniel
D
Flaherty
Matthew L
ML
Air
Ellen
E
Broderick
Joseph
J
Tsevat
Joel
J
D000368:Aged; D000465:Algorithms; D044383:Black People; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000473:pathology*; D015331:Cohort Studies; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality / Q000473:pathology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D044465:White People