A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke

Adrian D Wood, Nicholas D Gollop, Joao H Bettencourt-Silva, Allan B Clark, Anthony K Metcalf, Kristian M Bowles, Marcus Flather, John F Potter, Phyo K Myint

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Abstract

Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.
Original languageEnglish
Pages (from-to)407-413
Number of pages7
JournalJournal of Clinical Neurology
Volume12
Issue number4
Early online date30 Sep 2016
DOIs
Publication statusPublished - Oct 2016

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Hospital Mortality
Stroke
Odds Ratio
Mortality
Heart Failure
Registries
Comorbidity
Regression Analysis
Hemorrhage

Keywords

  • total anterior circulation stroke
  • risk factors
  • in-hospital mortality
  • prognosis
  • prognosis score
  • advanced age

Cite this

Wood, A. D., Gollop, N. D., Bettencourt-Silva, J. H., Clark, A. B., Metcalf, A. K., Bowles, K. M., ... Myint, P. K. (2016). A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke. Journal of Clinical Neurology, 12(4), 407-413. https://doi.org/10.3988/jcn.2016.12.4.407

A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke. / Wood, Adrian D; Gollop, Nicholas D; Bettencourt-Silva, Joao H; Clark, Allan B; Metcalf, Anthony K; Bowles, Kristian M; Flather, Marcus; Potter, John F; Myint, Phyo K.

In: Journal of Clinical Neurology, Vol. 12, No. 4, 10.2016, p. 407-413.

Research output: Contribution to journalArticle

Wood, AD, Gollop, ND, Bettencourt-Silva, JH, Clark, AB, Metcalf, AK, Bowles, KM, Flather, M, Potter, JF & Myint, PK 2016, 'A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke', Journal of Clinical Neurology, vol. 12, no. 4, pp. 407-413. https://doi.org/10.3988/jcn.2016.12.4.407
Wood, Adrian D ; Gollop, Nicholas D ; Bettencourt-Silva, Joao H ; Clark, Allan B ; Metcalf, Anthony K ; Bowles, Kristian M ; Flather, Marcus ; Potter, John F ; Myint, Phyo K. / A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke. In: Journal of Clinical Neurology. 2016 ; Vol. 12, No. 4. pp. 407-413.
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title = "A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke",
abstract = "Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82{\%} ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4{\%} mortality; score=1, 46.2{\%} mortality [negative predictive value (NPV)=70.6{\%}, positive predictive value (PPV)=46.2{\%}]; score=2, 64.1{\%} mortality (NPV=70.6, PPV=64.1{\%}); score=3, 73.7{\%} mortality (NPV=70.6{\%}, PPV=73.7{\%}); and score=4 or 5, 81.2{\%} mortality (NPV=70.6{\%}, PPV=81.2{\%}). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.",
keywords = "total anterior circulation stroke, risk factors, in-hospital mortality, prognosis, prognosis score, advanced age",
author = "Wood, {Adrian D} and Gollop, {Nicholas D} and Bettencourt-Silva, {Joao H} and Clark, {Allan B} and Metcalf, {Anthony K} and Bowles, {Kristian M} and Marcus Flather and Potter, {John F} and Myint, {Phyo K}",
note = "We thank the stroke datateam at the Norfolk and Norwich University Hospital for providing data. This work was supported by Stroke Services at the Norfolk and Norwich University Hospital Foundation NHS Trust Norfolk, which maintains the Norwich Clinical Stroke Register and Research Capability Funding from the Norfolk and Norwich University Hospital Research & Development Department.",
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doi = "10.3988/jcn.2016.12.4.407",
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T1 - A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke

AU - Wood, Adrian D

AU - Gollop, Nicholas D

AU - Bettencourt-Silva, Joao H

AU - Clark, Allan B

AU - Metcalf, Anthony K

AU - Bowles, Kristian M

AU - Flather, Marcus

AU - Potter, John F

AU - Myint, Phyo K

N1 - We thank the stroke datateam at the Norfolk and Norwich University Hospital for providing data. This work was supported by Stroke Services at the Norfolk and Norwich University Hospital Foundation NHS Trust Norfolk, which maintains the Norwich Clinical Stroke Register and Research Capability Funding from the Norfolk and Norwich University Hospital Research & Development Department.

PY - 2016/10

Y1 - 2016/10

N2 - Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.

AB - Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.

KW - total anterior circulation stroke

KW - risk factors

KW - in-hospital mortality

KW - prognosis

KW - prognosis score

KW - advanced age

U2 - 10.3988/jcn.2016.12.4.407

DO - 10.3988/jcn.2016.12.4.407

M3 - Article

VL - 12

SP - 407

EP - 413

JO - Journal of Clinical Neurology

JF - Journal of Clinical Neurology

SN - 1738-6586

IS - 4

ER -