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      • Record: found
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      Validation of the mSOAR and SOAR scores to predict early mortality in Chinese acute stroke patients

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          Abstract

          Background

          It is unclear in Chinese patients with acute stroke how the SOAR (stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestrike modified Rankin) and mSOAR (modified-SOAR) scores performed in predicting discharge mortality and 3-month mortality. We aimed to validate the predictability of these scores in this cohort.

          Methods

          Data from the China National Stroke Registry (CNSR) study was used to perform the mSOAR and SOAR scores for predicting the discharge and 3-month mortality in acute stroke patients.

          Results

          A total of 11073 acute stroke patients were included in present study. The increased mSOAR and SOAR scores were closely related to higher death risk in acute stroke patients. For discharge mortality, the area under the receiver-operator curve (AUC) of the mSOAR and SOAR scores were 0.784 (95% CI 0.761–0.807) and 0.722 (95% CI: 0.698–0.746). For 3-month mortality, they were 0.787 (95% CI: 0.771–0.803) and 0.704 (95% CI: 0.687–0.721), respectively. The mSOAR and SOAR scores showed significant correlation between the predicted and observed probabilities of discharge mortality (mSOAR: r = 0.945, P = 0.001; SOAR: r = 0.994, P<0.001) and 3-month mortality (mSOAR: r = 0.984, P<0.001; SOAR: r = 0.999; P<0.001).

          Conclusions

          The mSOAR score predicted reliably the risk of death in Chinese acute stroke patients.

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          Most cited references18

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          Classification and natural history of clinically identifiable subtypes of cerebral infarction.

          J. Bamford, P Sandercock, M. Dennis … (1991)
          We describe the incidence and natural history of four clinically identifiable subgroups of cerebral infarction in a community-based study of 675 patients with first-ever stroke. Of 543 patients with a cerebral infarct, 92 (17%) had large anterior circulation infarcts with both cortical and subcortical involvement (total anterior circulation infarcts, TACI); 185 (34%) had more restricted and predominantly cortical infarcts (partial anterior circulation infarcts, PACI); 129 (24%) had infarcts clearly associated with the vertebrobasilar arterial territory (posterior circulation infarcts, POCI); and 137 (25%) had infarcts confined to the territory of the deep perforating arteries (lacunar infarcts, LACI). There were striking differences in natural history between the groups. The TACI group had a negligible chance of good functional outcome and mortality was high. More than twice as many deaths were due to the complications of immobility than to direct neurological sequelae of the infarct. Patients in the PACI group were much more likely to have an early recurrent stroke than were patients in other groups. Those in the POCI group were at greater risk of a recurrent stroke later in the first year after the index event but had the best chance of a good functional outcome. Despite the small anatomical size of the infarcts in the LACI group, many patients remained substantially handicapped. The findings have important implications for the planning of stroke treatment trials and suggest that various therapies could be directed specifically at the subgroups.
          Article 0 comments Cited 301 times – based on 0 reviews     Review now
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            Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group.

            R Janzen, Peter U. Heuschmann, Joachim Röther … (2004)
            There is a lack of information about factors associated with in-hospital death and the impact of neurological complications on early outcome for patients with stroke treated in community settings. We investigated predictors for in-hospital mortality and attributable risks of death after ischemic stroke in a pooled analysis of large German stroke registers. Stroke patients admitted to hospitals cooperating within the German Stroke Registers Study Group (ADSR) between January 1, 2000, and December 31, 2000, were analyzed. The ADSR is a network of regional stroke registers, combining data from 104 academic and community hospitals throughout Germany. The impact of patients' demographic and clinical characteristics, their comorbid conditions, and the treating hospital expertise in stroke care on in-hospital mortality was analyzed using Cox regression analysis. Attributable risks of death for medical and neurological complications were calculated. A total of 13 440 ischemic stroke patients were included. Overall in-hospital mortality was 4.9%. In women, higher age (P<.001), severity of stroke defined by number of neurological deficits (P<.001), and atrial fibrillation (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.0-1.6) were independent predictors for in-hospital death. In men, diabetes (HR, 1.3; 95% CI, 1.0-1.8) and previous stroke (HR 1.4; 95% CI, 1.0-1.9) had a significant negative impact on early outcome in addition to the factors identified for women. The complication with the highest attributable risk proportion was increased intracranial pressure, accounting for 94% (95% CI, 93.9%-94.1%) of deaths among patients with this complication. Pneumonia was the complication with the highest attributable proportion of death in the entire stroke population, accounting for 31.2% (95% CI, 30.9%-31.5%) of all deaths. More than 50% of all in-hospital deaths were caused by serious medical or neurological complications (54.4%; 95% CI, 54.3%-54.5%). Substantial differences were found in the impact of comorbid conditions on early outcome for men and women. Programs aiming at an improvement in short-term outcome after stroke should focus especially on a reduction of pneumonia and an early treatment of increased intracranial pressure.
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              Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100.

              Carol Johnston, Mathew Reeves, Gustavo Saposnik … (2013)
              Age and stroke severity are major determinants of stroke outcomes, but systematically incorporating these prognosticators in the routine practice of acute ischemic stroke can be challenging. We evaluated the effect of an index combining age and stroke severity on response to IV tissue plasminogen activator (tPA) among patients in the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke trials. We created the Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index by combining age in years plus NIH Stroke Scale (NIHSS) ≥100. We applied the SPAN-100 index to patients in the NINDS tPA stroke trials (parts I and II) to evaluate its ability to predict clinical response and risk of intracerebral hemorrhage (ICH) after thrombolysis. The main outcome measures included ICH (any type) and a composite favorable outcome (defined as a modified Rankin Scale score of 0 or 1, NIHSS ≤1, Barthel index ≥95, and Glasgow Outcome Scale score of 1) at 3 months. Bivariate and multivariable logistic regression analyses were used to determine the association between SPAN-100 and outcomes of interest. Among 624 patients in the NINDS trials, 62 (9.9%) participants were SPAN-100 positive. Among those receiving tPA, ICH rates were higher for SPAN-100-positive patients (42% vs 12% in SPAN-100-negative patients; p < 0.001); similarly, ICH rates were higher in SPAN-100-positive patients (19% vs 5%; p = 0.005) among those not receiving tPA. SPAN-100 was associated with worse outcomes. The benefit of tPA, defined as favorable composite outcome at 3 months, was present in SPAN-100-negative patients (55.4% vs 40.2%; p < 0.001), but not in SPAN-100-positive patients (5.6% tPA vs 3.9%; p = 0.76). Similar trends were found for secondary outcomes (e.g., symptomatic ICH, catastrophic outcome, discharge home). The SPAN-100 index could be a simple method for estimating the clinical response and risk of hemorrhagic complications after tPA for acute ischemic stroke. These results need further confirmation in larger contemporary datasets.
              Article 0 comments Cited 88 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Xiaoying Wang: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 6 July 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 7
                Electronic Location Identifier: e0180444
                Affiliations
                [1 ]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
                [2 ]China National Clinical Research Center for Neurological Diseases, Beijing, China
                [3 ]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
                [4 ]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
                [5 ]Monogenic Disease Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
                [6 ]Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
                [7 ]Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria, IL, United States of America
                Massachusetts General Hospital, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: YSP YLW.

                • Data curation: YLW YSP.

                • Formal analysis: HW YSP.

                • Funding acquisition: YJW.

                • Investigation: YSP HW.

                • Methodology: YLW LPL HL DW XQZ.

                • Project administration: YLW XM.

                • Resources: YJW YLW.

                • Software: YSP.

                • Supervision: YJW YLW.

                • Validation: YSP HW.

                • Visualization: YSP HW.

                • Writing – original draft: HW YSP.

                • Writing – review & editing: YLW DW YJW XLL CJW.

                Author information
                http://orcid.org/0000-0002-4207-8071
                Article
                Publisher ID: PONE-D-16-49537
                DOI: 10.1371/journal.pone.0180444
                PMC ID: 5500336
                PubMed ID: 28683108
                SO-VID: 2bfacefb-e16d-49f5-afde-54ca6c4b87a3
                Copyright © © 2017 Wang et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 5 January 2017
                Date accepted : 15 June 2017
                Page count
                Figures: 3, Tables: 2, Pages: 10
                Funding
                Funded by: Ministry of Science and Technology of the People’s Republic of China
                Award ID: 2006BAI01A11, 2011BAI08B01, 2011BAI08B02, 2012ZX09303-005-001, 2013BAI09B03
                Funded by: Grant fromBeijing Biobank of Cerebral Vascular Disease
                Award ID: D131100005313003
                Funded by: Grant from Beijing Institute for Brain Disorders
                Award ID: BIBD-PXM2013_014226_07_000084
                This study was supported by grants from the Ministry of Science and Technology of the People’s Republic of China (2006BAI01A11, 2011BAI08B01, 2011BAI08B02, 2012ZX09303-005-001, 2013BAI09B03), a grant from the Beijing Biobank of Cerebral Vascular Disease (D131100005313003) and a grant from Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084).
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Hemorrhagic Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Stroke
                Subject: Hemorrhagic Stroke
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Ischemic Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Stroke
                Subject: Ischemic Stroke
                Subject: People and Places
                Subject: Population Groupings
                Subject: Ethnicities
                Subject: Chinese People
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Neuroimaging
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Neuroimaging
                Subject: People and Places
                Subject: Demography
                Subject: Death Rates
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: China
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Hemorrhage
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Hemorrhage
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Hemorrhage
                Custom metadata
                Data Availability Data are available from the Institutional Data Access/ Ethics Committee of the Beijing Tiantan Hospital for researchers who meet the criteria for access to confidential data. The data can be requested through the website of the data management system ( http://mrms.trials.com.cn/secure/login) or by sending email to the Institutional Review Board of the Beijing Tiantan Hospital (email: ttyyirb@ 123456163.com ).

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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