A Risk Score Based on Get With the Guidelines–Stroke Program Data Works in Patients With Acute Ischemic Stroke in China

Abstract

There are few validated models for prediction of in-hospital mortality after acute ischemic stroke. In 2010, Smith et al developed and internally validated models for predicting in-hospital mortality based on Get With the Guidelines-Stroke program data. We demonstrate the applicability of this Get With the Guidelines risk model in Chinese patients. The prognostic model was used to predict survival in 7015 patients with acute ischemic stroke from China National Stroke Registry data set. Model discrimination was quantified by calculating C statistic. To clarify the role of National Institutes of Health Stroke Scale (NIHSS), we also calculated the C statistics for NIHSS alone and for the model without NIHSS. The C statistic was 0.867 (95% CI, 0.839-0.895) through the Get With the Guidelines risk model, suggesting good discrimination in the China National Stroke Registry. The model without NIHSS produced significantly lower C statistic (0.735; 95% CI, 0.701-0.770; P<0.001), indicating the important role of NIHSS in the prediction of survival. Furthermore, a model with NIHSS alone also provided significant discrimination (C statistic, 0.847; 95% CI, 0.816-0.879). A plot of observed versus predicted mortality showed excellent model calibration in the external validation sample from the China National Stroke Registry. The Get With the Guidelines risk model could correctly predict in-hospital mortality in Chinese patients with ischemic stroke. In addition, the NIHSS provides substantial incremental information on a patient's short-term mortality risk and is the strongest predictor of mortality.