Abstract
Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96–9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62–3.14), eGFR < 15 (1.97, 1.55–2.52), 1-year increment in age (1.04, 1.04–1.05), liver disease (1.50, 1.20–1.87), peripheral vascular disease (1.39, 1.23–1.57), cancers (1.37, 1.27–1.47), heart failure (1.24, 1.15–1.34), 1-point increment in pre-stroke mRS (1.20, 1.17–1.22), atrial fibrillation (1.17, 1.10–1.24), coronary heart disease (1.09, 1.02–1.16), chronic obstructive pulmonary disease (1.13, 1.03–1.25) and hypertension (0.77, 0.72–0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.
Highlights
Despite prevention, treatment advances and extensive research, stroke continues to pose a significant global health burden
Outcomes considered in previously developed scores include inhospital, 3 months, 6 months, 1-year mortality, stroke recurrence as well as functional outcomes: mRS and hospital length of stay [4,5,6]
We aimed to develop and internally validate a score using readily available clinical information at the time of stroke to predict 10-year ischaemic stroke mortality
Summary
Treatment advances and extensive research, stroke continues to pose a significant global health burden. It causes significant societal and economic hardship, with stroke costs representing 3–4% of total health care expenditures in Western countries [1]. Clinical prediction scores provide clinicians, patients and their families with information that can facilitate decisions about their care, identifying those at high risk who require immediate intervention. They provide very important information on patient prognosis. Whilst many stroke scores provide clinicians with short-term mortality and disability prognosis, so far none of them can predict 10-year mortality
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