The baseline NIHSS score in female and male patients and short-time outcome: a study in young ischemic stroke

Abstract

The NIH Stroke Scale (NIHSS) may not appropriately assess the spectrum of young sex-related stroke neurologic deficits. We determined the cutoff baseline NIHSS score that predicts independent daily life activity at discharge in young male versus female ischemic strokes. We conducted this study in 1,451 young Chinese adults with acute cerebral ischemic stroke as determined by the modified Rankin Scale (mRS) at discharge. The main outcome measures included a composite favorable outcome (defined as a mRS score of 0 or 2) and poor outcome (defined as a mRS score of 3 or 6) at discharge. Bivariate logistic regression analyses were used to determine the risk factors of outcome at discharge in male and female patients respectively, receiver operating characteristic (ROC) curves and calculated the area under the ROC curve with 95% CIs. P<0.05 was considered significant. Stepwise logistic regression analysis confirmed the risk factors of outcome included: diabetes mellitus, hyperlipidemia, stroke subtype and baseline NIHSS score in male patient; atrial fibrillation, stroke subtype and baseline NIHSS score in female patients. The optimal cutoff score of the baseline NIHSS was ≤4 for female patients with stroke, the optimal cutoff score of the baseline NIHSS was ≤6 for male patients with stroke. The cutoff score of the baseline NIHSS for a favorable outcome at discharge was relatively low in young female patients compared to male patients. These results need further confirmation in larger contemporary datasets.