Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

Azmil H. Abdul-Rahim; Terence J. Quinn; Sarah Alder; Allan B. Clark; Stanley D. Musgrave; Peter Langhorne; John F. Potter; Phyo Kyaw Myint

doi:10.1161/STROKEAHA.115.009898

Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

Azmil H. Abdul-Rahim, Terence J. Quinn, Sarah Alder, Allan B. Clark, Stanley D. Musgrave, Peter Langhorne, John F. Potter, Phyo Kyaw Myint

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

11 Downloads (Pure)

Abstract

BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.

METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.

RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).

CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.

Original language	English
Pages (from-to)	74-79
Number of pages	6
Journal	Stroke
Volume	47
Issue number	1
Early online date	17 Nov 2015
DOIs	https://doi.org/10.1161/STROKEAHA.115.009898
Publication status	Published - Jan 2016
Event	European Stroke Organisation Conference - Glasgow, United Kingdom Duration: 17 Apr 2015 → 19 Apr 2015

Bibliographical note

We thank all who were involved in the Anglia Stroke and Heart Clinical Network data. Dr Myint supervised the project. Drs Abdul-Rahim, Alder, and Clark conducted the analyses. Drs Abdul-Rahim and Quinn drafted the initial article. Drs Abdul-Rahim, Quinn, Clark, and Myint involved in reviewing and reporting of the work. All authors provided critical revision of the article for important intellectual content and approved the final version.

Keywords

calibration
inpatients
mortality
prognosis
stroke

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Accepted ManuscriptAccepted author manuscript, 342 KBLicence: Unspecified

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Phyo Myint, Clinical Chair in Medicine of Old Age
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic

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Abdul-Rahim, A. H., Quinn, T. J., Alder, S., Clark, A. B., Musgrave, S. D., Langhorne, P., Potter, J. F., & Myint, P. K. (2016). Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. Stroke, 47(1), 74-79. https://doi.org/10.1161/STROKEAHA.115.009898

Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. / Abdul-Rahim, Azmil H.; Quinn, Terence J.; Alder, Sarah et al.
In: Stroke, Vol. 47, No. 1, 01.2016, p. 74-79.

Research output: Contribution to journal › Article › peer-review

Abdul-Rahim, AH, Quinn, TJ, Alder, S, Clark, AB, Musgrave, SD, Langhorne, P, Potter, JF & Myint, PK 2016, 'Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke', Stroke, vol. 47, no. 1, pp. 74-79. https://doi.org/10.1161/STROKEAHA.115.009898

Abdul-Rahim AH, Quinn TJ, Alder S, Clark AB, Musgrave SD, Langhorne P et al. Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. Stroke. 2016 Jan;47(1):74-79. Epub 2015 Nov 17. doi: 10.1161/STROKEAHA.115.009898

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title = "Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke",

abstract = "BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.",

keywords = "calibration, inpatients, mortality, prognosis, stroke",

author = "Abdul-Rahim, {Azmil H.} and Quinn, {Terence J.} and Sarah Alder and Clark, {Allan B.} and Musgrave, {Stanley D.} and Peter Langhorne and Potter, {John F.} and Myint, {Phyo Kyaw}",

note = "We thank all who were involved in the Anglia Stroke and Heart Clinical Network data. Dr Myint supervised the project. Drs Abdul-Rahim, Alder, and Clark conducted the analyses. Drs Abdul-Rahim and Quinn drafted the initial article. Drs Abdul-Rahim, Quinn, Clark, and Myint involved in reviewing and reporting of the work. All authors provided critical revision of the article for important intellectual content and approved the final version.; European Stroke Organisation Conference ; Conference date: 17-04-2015 Through 19-04-2015",

year = "2016",

month = jan,

doi = "10.1161/STROKEAHA.115.009898",

language = "English",

volume = "47",

pages = "74--79",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "1",

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TY - JOUR

T1 - Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

AU - Abdul-Rahim, Azmil H.

AU - Quinn, Terence J.

AU - Alder, Sarah

AU - Clark, Allan B.

AU - Musgrave, Stanley D.

AU - Langhorne, Peter

AU - Potter, John F.

AU - Myint, Phyo Kyaw

N1 - We thank all who were involved in the Anglia Stroke and Heart Clinical Network data. Dr Myint supervised the project. Drs Abdul-Rahim, Alder, and Clark conducted the analyses. Drs Abdul-Rahim and Quinn drafted the initial article. Drs Abdul-Rahim, Quinn, Clark, and Myint involved in reviewing and reporting of the work. All authors provided critical revision of the article for important intellectual content and approved the final version.

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.

AB - BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.

KW - calibration

KW - inpatients

KW - mortality

KW - prognosis

KW - stroke

U2 - 10.1161/STROKEAHA.115.009898

DO - 10.1161/STROKEAHA.115.009898

M3 - Article

C2 - 26578661

SN - 0039-2499

VL - 47

SP - 74

EP - 79

JO - Stroke

JF - Stroke

IS - 1

T2 - European Stroke Organisation Conference

Y2 - 17 April 2015 through 19 April 2015

ER -

Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

Abstract

Bibliographical note

Keywords

Access to Document

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Profiles

Phyo Myint, Clinical Chair in Medicine of Old Age

Cite this