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ASTRAL score predicts 5-year dependence and mortality in acute ischemic stroke
Vasileios Papavasileiou1, Haralampos Milionis, Patrik Michel
1Department of Medicine, University of Thessaly, Biopolis 41110, Larissa, Greece.
Insights
The ASTRAL score accurately predicts long-term outcomes in acute ischemic stroke patients. This score reliably forecasts both functional status and mortality up to five years post-stroke.
Area of Science:
- Neurology
- Clinical Medicine
- Stroke Research
Background:
- The ASTRAL score demonstrated consistency in predicting 3-month outcomes for acute ischemic stroke.
- External validation confirmed its reliability for short-term prognosis.
Purpose of the Study:
- To evaluate the prognostic accuracy of the ASTRAL score for predicting 5-year outcomes in acute ischemic stroke patients.
- To assess its ability to predict long-term functional status and mortality.
Main Methods:
- Analysis of consecutive acute ischemic stroke patients from the Athens Stroke Registry (1998-2010).
- Exclusion of patients admitted >24 hours post-symptom onset or with missing ASTRAL score components.
- Assessment of 5-year unfavorable functional outcome (modified Rankin Scale 3-6) and mortality using ROC curves and Cox proportional hazards analysis.
Main Results:
- The ASTRAL score achieved an AUC of 0.89 for predicting 5-year unfavorable functional outcome.
- It was independently associated with 5-year unfavorable functional outcome (HR 1.09) and mortality (HR 1.09).
- The AUC for predicting 5-year mortality was 0.81, with significantly lower survival probabilities for higher ASTRAL score quartiles.
Conclusions:
- The ASTRAL score is a reliable tool for predicting 5-year functional outcome in acute ischemic stroke patients.
- It also demonstrates strong predictive power for 5-year mortality in this patient group.
Background And Purpose:
The ASTRAL score was externally validated showing remarkable consistency on 3-month outcome prognosis in patients with acute ischemic stroke. The present study aimed to evaluate ASTRAL score's prognostic accuracy to predict 5-year outcome.
Methods:
All consecutive patients with acute ischemic stroke registered in the Athens Stroke Registry between January 1, 1998, and December 31, 2010, were included. Patients were excluded if admitted >24 hours after symptom onset or if any ASTRAL score component was missing. End points were 5-year unfavorable functional outcome, defined as modified Rankin Scale 3 to 6, and 5-year mortality. For each outcome, the area under the receiver operating characteristics curve was calculated; also, a multivariate Cox proportional hazards analysis was performed to investigate whether the ASTRAL score was an independent predictor of outcome. The Kaplan-Meier product limit method was used to estimate the probability of 5-year survival for each ASTRAL score quartile.
Results:
The area under the receiver operating characteristics curve of the score to predict 5-year unfavorable functional outcome was 0.89, 95% confidence interval 0.88 to 0.91. In multivariate Cox proportional hazards analysis, the ASTRAL score was independently associated with 5-year unfavorable functional outcome (hazard ratio, 1.09; 95% confidence interval, 1.08-1.10). The area under the receiver operating characteristics curve for the ASTRAL score's discriminatory power to predict 5-year mortality was 0.81 (95% confidence interval, 0.78-0.83). In multivariate analysis, the ASTRAL score was independently associated with 5-year mortality (hazard ratio, 1.09, 95% confidence interval, 1.08-1.10). During the 5-year follow-up, the probability of survival was significantly lower with increasing ASTRAL score quartiles (log-rank test <0.001).
Conclusions:
The ASTRAL score reliably predicts 5-year functional outcome and mortality in patients with acute ischemic stroke.
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