title: Early function decline after ischemic stroke can be predicted by a nomogram based on age, use of thrombolysis, RDW and NIHSS score at admission.
abstract: The availability of prediction tools for risk stratification after acute stroke is seen as a valuable perspective for tailored clinical management. This retrospective study was aimed to identify significant predictors of poor outcome in patients presenting with acute ischemic stroke, which could then be used for constructing a prediction model. The study population consisted of 837 patients admitted to the Stoke Unit of University Hospital of Verona (Italy) for acute ischemic stroke within 12 h of symptoms onset. In multivariate analysis, age, use of thrombolysis, red blood cell distribution width (RDW) and NIHSS score at admission were found to be significant predictors of 3-month functional decline. A nomogram constructed by integrating these four variables exhibited an area under the curve of 0.832 for predicting functional impairment. The >80% risk cut-off derived from the nomogram was associated with 0.91 positive predictive value, whereas a risk probability <10% displayed 0.93 negative predictive value for predicting functional impairment. These results demonstrate that a prediction tool integrating some important clinical, laboratory and demographic variables may enable an efficient risk stratification of poor outcome after acute stroke.
authors.affiliation: Emergency Department, University Hospital of Verona, Verona, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Turcato
authors.affiliation: Emergency Department, University Hospital of Parma, Parma, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
authors.affiliation: Department of Neurology and Stroke Unit, University Hospital of Verona, Verona, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cappellari
authors.affiliation: Emergency Department, University Hospital of Verona, Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bonora
authors.affiliation: Emergency Department, University Hospital of Verona, Verona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Zannoni
authors.affiliation: Department of Neurology and Stroke Unit, University Hospital of Verona, Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bovi
authors.affiliation: Emergency Department, University Hospital of Verona, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Section of Clinical Biochemistry, University of Verona, Piazzale LA Scuro, 37100, Verona, Italy. giuseppe.lippi@univr.it.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0001-9523-9054
authors.initials: G
authors.lastname: Lippi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia; D004912:Erythrocytes / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D015912:Thrombolytic Therapy
keywords: Cerebral ischemia; Nomogram; Outcome; Prediction; Red blood cell distribution width; Stroke