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Updated: Oct 23, 2025

Establishing a Competing Risk Regression Nomogram Model for Survival Data
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Predicting 10-year stroke mortality: development and validation of a nomogram.

Weronika A Szlachetka1, Tiberiu A Pana1, Mamas A Mamas2

  • 1Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.

Acta Neurologica Belgica
|August 18, 2021
PubMed
Summary

This study developed a new 10-year prediction score for ischaemic stroke mortality using routine clinical data. The score identifies key predictors to aid in forecasting long-term survival after stroke.

Keywords:
Cerebrovascular diseaseIschaemic strokeLong-term mortalityPrediction scorePrognosis

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Area of Science:

  • Neurology
  • Cardiology
  • Epidemiology

Background:

  • Predicting long-term mortality after ischaemic stroke is crucial for patient management and healthcare planning.
  • Existing prediction models often lack a specific focus on 10-year survival or may not utilize routinely collected data.

Purpose of the Study:

  • To develop and internally validate a prediction score for 10-year mortality following a first-ever ischaemic stroke.
  • To identify key clinical predictors associated with long-term mortality in ischaemic stroke patients.

Main Methods:

  • A UK-based cohort study included 10,366 patients with first-ever ischaemic stroke (2003-2016).
  • Cox proportional-hazards models were employed to identify predictors of 10-year post-admission mortality.
  • Internal validation was performed using bootstrap resampling, and a nomogram was created for clinical application.

Main Results:

  • Key predictors of 10-year mortality included age, stroke severity (e.g., total anterior circulation syndrome), estimated glomerular filtration rate (eGFR), pre-stroke functional status (modified Rankin Score), and comorbidities (e.g., atrial fibrillation, heart failure, cancer).
  • The internally validated model demonstrated good discrimination (c-statistic: 0.76) and calibration (calibration slope: 0.98).
  • The developed score utilizes readily available point-of-care information.

Conclusions:

  • The study presents the first prediction score specifically for 10-year mortality after ischaemic stroke.
  • This score, based on routinely collected data, can assist clinicians in assessing long-term prognosis.
  • Further external validation is recommended to confirm the model's generalizability.