Development of a new non invasive prognostic stroke scale (NIPSS) including triage elements for sleep apnea and peripheral artery disease |
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| Institution: | 1. Post-Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Brazil (UFBA), Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA, Sala 421, Rua Reitor Miguel Calmón, Sem Número, Bairro Canela, Salvador 40110-100, Brazil;2. Stroke Unit, Hospital Geral Roberto Santos, Brazil;3. Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA, Brazil;4. Universidade Faculdade de Salvador (UNIFACS), Bahia, Brazil;1. Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan;2. Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan;3. Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-shi, Tokyo, 192-0392, Japan;1. Department of Neurosurgery, Iwate Medical University, Iwate, Japan;2. Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan;1. Assistant professor Sedat Yasin, Department of Neurology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey;2. Associate Professor Erman Altunisik, Department of Neurology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey;1. Department of Neurology, CHU Nîmes, University Montpellier, CHU Nîmes, Hôpital Carémeau, 4, Rue du Pr Debré, Nîmes 30900, France;2. Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology, CHU Nîmes, University Montpellier, Nîmes, France;3. Institut de Génomique Fonctionnelle, CNRS UMR5203, INSERM 1191, University Montpellier, Montpellier, France;1. Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan;2. Department of Neurosurgery, Maebashi Neurosurgical Clinic, Maebashi, Gunma, Japan;1. Department of Haematology, Oslo University Hospital Rikshospitalet, Sognsveien 20, Oslo 0372, Norway;2. Department of Haematology, Akershus University Hospital, Sykehusveien 25, 1478 Nordbyhagen, Lørenskog, Norway;3. Department of Microbiology, Oslo University Hospital Rikshospitalet, Sognsveien 20, Oslo 0372, Norway.;4. Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Sykehusveien 38, Tromsø 9019, Norway;5. Department of Immunology and Transfusion Medicine, Oslo University Hospital, Ullevål, Kirkeveien 166, Oslo 0450, Norway;6. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Klaus Torgårdsvei 3, Oslo 0372, Norway;7. Department of Neurology, Oslo University Hospital Rikshospitalet, Sognsveien 20, Oslo 0372, Norway;8. Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Sognsveien 20, Oslo 0372, Norway;9. Department of Neurosurgery, Oslo University Hospital Rikshospitalet. Sognsveien 20, Oslo 0372, Norway |
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| Abstract: | BackgroundAlthough sleep apnea and peripheral artery disease are prognostic factors for stroke, their added benefit in the acute stage to further prognosticate strokes has not been evaluated.ObjectivesWe tested the accuracy in the acute stroke stage of a novel score called the Non-Invasive Prognostic Stroke Scale (NIPSS).Patients and methodsProspective cohort with imaging-confirmed ischemic stroke. Clinical data, sleep apnea risk score (STOPBANG) and blood pressure measures were collected at baseline. Primary outcome was the 90-day modified Rankin Scale (mRS), with poor outcome defined as mRS 3-6. Area under the ROC curve (AUC) was calculated for NIPSS and compared to six other stroke prognostic scores in our cohort: SPAN-100 index, S-SMART, SOAR, ASTRAL, THRIVE, and Dutch Stroke scores.ResultsWe enrolled 386 participants. After 90 days, there were 56% with poor outcome, more frequently older, female predominant and with higher admission National Institute of Health Stroke Scale (NIHSS). Four variables remained significantly associated with primary endpoint in the multivariable model: age (OR 1.87), NIHSS (OR 7.08), STOPBANG category (OR 1.61), and ankle-braquial index (OR 2.11). NIPSS AUC was 0.86 (0.82–0.89); 0.83 (0.79-0.87) with bootstrapping. When compared to the other scores, NIPSS, ASTRAL, S-SMART and DUTCH scores had good abilities in predicting poor outcome, with AUC of 0.86, 0.86, 0.83 and 0.82, respectively. THRIVE, SOAR and SPAN-100 scores were fairly predictive.Discussion and conclusionsNon-invasive and easily acquired emergency room data can predict clinical outcome after stroke. NIPSS performed equal to or better than other prognostic stroke scales. |
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