不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较

doi:10.3969/j.issn.1006-9771.2021.03.002

Abstract

Abstract: Objective

To compare the prediction of Ischemic Stroke Predictive Risk Score (iScore), Preadmission Comorbidities, Level of Consciousness, Age, and Neurologic Deficit (PLAN), Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and Totaled Health Risks in Vascular Events (THRIVE) for short- and long-term death for patients with acute ischemic stroke (AIS).

Methods

From August, 2015 to June, 2018, 323 AIS patients in emergency ward were included, and followed up 30 days, three months and a year after including. Receiver operating characteristic (ROC) curve was used to analyze the predictive effects of iScore, PLAN, ASTRAL and THRIVE.

Results

The all-cause mortality 30 days, three months and a year after including was 12.4% (40/323), 17.3% (56/323) and 25.7% (83/323), respectively. The area under curve (AUC) from more to less arranged as iScore, PLAN, ASTRAL and THRIVES. There was significant difference of AUC between iScore and THRIVE (Z > 1.990, P < 0.05), but not among the others (Z < 1.943, P > 0.05).

Conclusion

iScore, PLAN, ASTRAL and THRIVE may predict short- and long-term death of AIS patients in the emergency well, and iScore is the best. However, the procedure of iScore is complex, it is recommended to use PLAN and ASTRAL for emergency.

Key words: acute ischemic stroke, death, pronosis

CLC Number:

R743.3

Na WANG,Pei-lan LI,Lu-shan LIU,Feng-rong WANG. Prediction of Short- and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 256-260.

Figures/Tables 3

References 27

1	Feigin V L, Norrving B, Mensah G A. Global burden of stroke [J]. Circ Res, 2017, 120(3): 439-448.
2	Benjamin E J, Blaha M J, Chiuve S E, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 update: a report from the American Heart Association [J]. Circulation, 2017, 135(10): e146-e603.
3	Saposnik G, Kapral M K, Liu Y, et al. IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke [J]. Circulation, 2011, 123(7): 739-749.
4	O'Donnell M J, Fang J, D'Uva C, et al. The PLAN score: a bedside prediction rule for death and severe disability following acute ischemic stroke [J]. Arch Intern Med, 2012, 172(20): 1548-1556.
5	Ntaios G, Faouzi M, Ferrari J, et al. An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score [J]. Neurology, 2012, 78(24): 1916-1922.
6	Flint A C, Cullen S P, Faigeles B S, et al. Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score [J]. Am J Neuroradiol, 2010, 31(7): 1192-1196.
7	Adams H J, Bendixen B H, Kappelle L J, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment [J]. Stroke, 1993, 24(1): 35-41.
8	Xu J, Tao Y, Xie X, et al. A comparison of mortality prognostic scores in ischemic stroke patients [J]. J Stroke Cerebrovasc Dis, 2016, 25(2): 241-247.
9	Soriano-Tárraga C, Mola-Caminal M, Giralt-Steinhauer E, et al. Biological age is better than chronological as predictor of 3-month outcome in ischemic stroke [J]. Neurology, 2017, 89(8): 830-836.
10	李姝雅,赵性泉,刘丽萍,等. 3种评分工具对缺血性卒中伴心房颤动患者1年死亡风险评估的验证[J]. 中国卒中杂志, 2018, 13(8): 818-822.
	Li S Y, Zhao X Q, Liu L P, et al. Validity comparison of three scores tool for 1-year death risk assessment in Chinese ischemic stroke patients with atrial fibrillation [J]. Chin J Stroke, 2018, 13(8): 818-822.
11	Wang W Y, Sang W W, Jin D, et al. The prognostic value of the iScore, the PLAN score, and the ASTRAL score in acute ischemic stroke [J]. J Stroke Cerebrovasc Dis, 2017, 26(6): 1233-1238.
12	Bejot Y, Daubail B, Sensenbrenner B, et al. iScore for predicting institutional care after ischemic stroke: a population-based study [J]. J Stroke Cerebrovasc Dis, 2015, 24(3): 694-698.
13	Ewara E M, Isaranuwatchai W, Bravata D M, et al. The iScore predicts total healthcare costs early after hospitalization for an acute ischemic stroke [J]. Int J Stroke, 2015, 10(8): 1179-1186.
14	van Hooff R J, Nieboer K, de Smedt A, et al. Validation assessment of risk tools to predict outcome after thrombolytic therapy for acute ischemic stroke [J]. Clin Neurol Neurosur, 2014, 125: 189-193.
15	Saposnik G, Raptis S, Kapral M K, et al. The iScore predicts poor functional outcomes early after hospitalization for an acute ischemic stroke [J]. Stroke, 2011, 42(12): 3421-3428.
16	Saposnik G, Demchuk A, Tu J V, et al. The iScore predicts efficacy and risk of bleeding in the national institute of neurological disorders and stroke tissue plasminogen activator stroke trial [J]. J Stroke Cerebrovasc Dis, 2013, 22(6): 876-882.
17	Reid J M, Dai D W, Delmonte S, et al. Simple prediction scores predict good and devastating outcomes after stroke more accurately than physicians [J]. Age Ageing, 2017, 46(3): 421-426.
18	Papavasileiou V, Milionis H, Michel P, et al. ASTRAL score predicts 5-year dependence and mortality in acute ischemic stroke [J]. Stroke, 2013, 44(6): 1616-1620.
19	Liu G, Ntaios G, Zheng H, et al. External validation of the ASTRAL score to predict 3- and 12-month functional outcome in the China National Stroke Registry [J]. Stroke, 2013, 44(5): 1443-1445.
20	Cooray C, Mazya M, Bottai M, et al. External validation of the ASTRAL and DRAGON scores for prediction of functional outcome in stroke [J]. Stroke, 2016, 47(6): 1493-1499.
21	Kuster G W, Dutra L A, Brasil I P, et al. Performance of four ischemic stroke prognostic scores in a Brazilian population [J]. Arq Neuro-Psiquiatr, 2016, 74(2): 133-137.
22	Ntaios G, Gioulekas F, Papavasileiou V, et al. ASTRAL, DRAGON and SEDAN scores predict stroke outcome more accurately than physicians [J]. Eur J Neurol, 2016, 23(11): 1651-1657.
23	Kastrup A, Brunner F, Hildebrandt H, et al. THRIVE score predicts clinical and radiological outcome after endovascular therapy or thrombolysis in patients with anterior circulation stroke in everyday clinical practice [J]. Eur J Neurol, 2017, 24(8): 1032-1039.
24	Chen W, Liu G, Fang J,et al. External validation of the Totaled Health Risks in Vascular Events score to predict functional outcome and mortality in patients entered into the China National Stroke Registry [J]. J Stroke Cerebrovasc Dis, 2016, 25(10): 2331-2337.
25	金迪,陈忠云,李婧,等. iScore、PLAN和ASTRAL评分对急性缺血性卒中患者不良结局风险预测价值探讨[J]. 神经损伤与功能重建, 2014, 9(3): 209-213.
	Jing D, Chen Z Y, Li J, et al. External validation of the iScore, PLAN score and ASTRAL score to predict functional outcomes for acute ischemic stroke [J]. Neural Injury Function Reconstruct, 2014, 9(3): 209-213.
26	Shen B, Yang X, Sui R B, et al. The Prognostic value of the THRIVE score, the iScore score and the ASTRAL score in Chinese patients with acute ischemic stroke [J]. J Stroke Cerebrovasc Dis, 2018, 27(10): 2877-2886.
27	Matsumoto K, Nohara Y, Soejima H, et al. Stroke prognostic scores and data-driven prediction of clinical outcomes after acute ischemic stroke [J]. Stroke, 2020, 51(5): 1477-1483.

项目	统计值
性别(n)
男	170
女	153
年龄(岁)	76(63, 83)
住院时间(d)	12(6, 14)
房颤(n)	67
高血压(n)	251
糖尿病(n)	124
冠心病(n)	106
脑卒中史(n)	153
临床类型(n)
腔隙性梗死	166
部分前循环梗死	53
完全前循环梗死	54
后循环梗死	50
GCS	12(10, 15)
NIHSS	7(2, 13)
iScore (30 d)	125(96, 176)
iScore (1年)	127(98, 177)
PLAN	12.0(9.5, 15.0)
ASTRAL	23.2(18.4, 32.0)
THRIVE	4(3, 5)
30 d死亡(n)	40
3个月死亡(n)	56
1年死亡(n)	83

时间	评分系统	AUC (95%CI)	切点(分)	约登指数	敏感性	特异性	H-L检验(P值)
30 d	iScore (30 d)	0.892(0.852~0.923)	164	0.6736	0.80	0.87	6.553(0.586)
	PLAN	0.891(0.852~0.923)	14.8	0.6948	0.82	0.88	8.029(0.431)
	ASTRAL	0.882(0.842~0.915)	27.4	0.6314	0.73	0.90	4.763(0.783)
	THRIVE	0.841(0.797~0.880)	4	0.6442	0.69	0.90	7.079(0.132)
3个月	iScore (30 d)	0.877(0.836~0.910)	164	0.6491	0.83	0.82	8.231(0.413)
	PLAN	0.871(0.830~0.906)	14.2	0.6154	0.79	0.82	6.575(0.563)
	ASTRAL	0.870(0.829~0.905)	27.4	0.6235	0.76	0.84	4.765(0.782)
	THRIVE	0.821(0.775~0.865)	4	0.5800	0.72	0.86	8.946(0.062)
1年	iScore (1年)	0.876(0.835~0.910)	164	0.6257	0.87	0.76	10.946(0.205)
	PLAN	0.875(0.834~0.909)	12.7	0.6411	0.74	0.90	6.343(0.609)
	ASTRAL	0.870(0.829~0.905)	27.4	0.5873	0.80	0.78	7.837(0.450)
	THRIVE	0.828(0.783~0.868)	4	0.5618	0.77	0.80	6.717(0.152)

时间	评分系统	差异	Z值	P值
30 d	iScore vs. PLAN	0.000	0.015	0.988
	iScore vs. ASTRAL	0.009	0.692	0.489
	iScore vs. THRIVE	0.050	1.990	0.047
	PLAN vs. ASTRAL	0.009	0.027	0.743
	PLAN vs. THRIVE	0.050	1.789	0.074
	ASTRAL vs. THRIVE	0.041	1.497	0.134
3个月	iScore vs. PLAN	0.005	0.211	0.833
	iScore vs. ASTRAL	0.006	0.489	0.635
	iScore vs. THRIVE	0.055	2.195	0.028
	PLAN vs. ASTRAL	0.001	0.049	0.961
	PLAN vs. THRIVE	0.050	1.805	0.071
	ASTRAL vs. THRIVE	0.005	1.845	0.065
1年	iScore vs. PLAN	0.001	0.053	0.958
	iScore vs. ASTRAL	0.006	0.549	0.583
	iScore vs. THRIVE	0.048	2.209	0.022
	PLAN vs. ASTRAL	0.005	0.244	0.807
	PLAN vs. THRIVE	0.047	1.912	0.056
	ASTRAL vs. THRIVE	0.042	1.943	0.052

[1]	DENG Ting, CHEN Jingmian, LIU Xiaomeng, YAO Xiaohua, LIU Lushan, HE Wei, ZHANG Tong, LU Haitao. Risk factors of stroke-associated pneumonia for patients with mild to moderate acute ischemic stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 708-713.
[2]	ZHANG Chunlong, LIU Fuliang, SHANG Na, LI Fang, LIU Huizhen. Association of serum adiponectin and high sensitivity C-reactive protein levels to short-term outcome in patients with acute ischemic stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1221-1226.
[3]	LIU Hui-zhen,GUO Shu-bin,SHANG Na,LI Fang,LIU Lu-shan,LI Pei-lan,CHEN Jing-mian,WANG Feng-rong,LI Jun-yu. Prediction of Serum 25-Hydroxyvitamin D for Outcome of Acute Ischemic Stroke in Emergency [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 830-835.
[4]	WANG Na, LIU Lu-shan, WANG Feng-rong. Comparison of Four Scoring Systems in Predicting Risk of Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(6): 696-701.
[5]	ZHANG Lu-yong;ZHANG Miao;LIU Shi-bu;LI Rui. Autophagic Cell Death in Glioma Cell Induced by Ceramide through JNK/c-Jun Pathway [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2015, 21(08): 905-912.
[6]	LIU Xiao-ye;DONG Hao;TU Wen-jun;et al.. Prediction of Combination of High-sensitivity C-reactive Protein and Homocysteine on Short-term Outcomes of Patients with Acute Ischemic Stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2014, 20(4): 347-350.
[7]	ZHAO Li-li;LI Tang-di;MA Hong-ying;LI Yu-xia;ZHANG Xi-cheng. . Investigation of the Cause of Death in Patients with Spinal Cord Injury from Tangshan Earthquake (1976) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2014, 20(10): 975-978.
[8]	LIU Jia;SUN Tian-sheng.. Role of Necroptosis in Central Nervous System Injury and Repair (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2014, 20(1): 53-55.
[9]	LI Ying-hong.. Effect of Xuefuzhuyu Decoction on Acute Ischemic Stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2013, 19(3): 263-265.
[10]	LI Qiu-ying;SONG Chong-sheng;YANG Fu-de;et al. Retrospective Analysis of Death Causes and Related Factors among Psychiatric Inpatients over 10 Years: 159 Cases Report [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2010, 16(8): 794-796.
[11]	HUANG Xiao-qin;JIA Jian-ping;MA Qing-feng;et al.. NIHSS with CT Angiography for Clinical Prognosis of Acute Ischemic Stroke at Ultra-early Stage [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2010, 16(2): 109-112.
[12]	REN Yan-chun;ZHANG Bing;TIAN Shuo;et al. Relation between Erectile Dysfunction and Myocardial Infarction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2010, 16(12): 1178-1179.
[13]	ZHAO Chun-yu;NIUZhu;ZHANG Tong;et al. Establishment of Focal Cerebral Ischemia Model with Modified Suture-occluded Method in Period of Rehabilitation and Analysis for Death Cause [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(10): 916-918.
[14]	CHEN Zhen-xia. Causes of Death of Old or No-old Psychopathic Inpatients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(05): 497-498.
[15]	LIU Jian-guo;WANG Yu-tang. Advance in Research of Stress and Ventricular Arrhythmias (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(02): 155-156.

Prediction of Short- and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 27

Related Articles 15

Metrics

Comments

Recommended 0