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Prognostic Models of Mortality Following First-Ever Acute Ischemic Stroke: A Population-Based Retrospective Cohort
Mustapha Mohammed1, Hadzliana Zainal2, Siew Chin Ong2
1QU Health Qatar University Doha Qatar.
Health Science Reports
|February 17, 2025
Summary
This study developed a validated prognostic model to predict mortality after acute ischemic stroke. Key predictors include age, NIHSS score, and diabetes, while treatments like antiplatelets and rehabilitation improve outcomes.
Area of Science:
- Neurology
- Public Health
- Biostatistics
Background:
- Lack of population-based studies on guideline-based prognostic models for stroke.
- Need for a validated model to predict mortality after first-ever acute ischemic stroke.
Purpose of the Study:
- To develop and validate a prognostic model for predicting 90-day mortality following a first-ever acute ischemic stroke.
- To identify key predictors of mortality in acute stroke patients.
Main Methods:
- Utilized logistic regression on data from 899 patients in the Malaysian National Stroke Registry (NSR) (2009-2019).
- Model developed using 75% of data and internally validated on the remaining 25%.
- Assessed model performance using discrimination (AUC) and calibration (Hosmer-Lemeshow test).
Main Results:
- The final model identified age, NIHSS score, and diabetes as mortality risk factors.
- Protective factors included antiplatelet therapy, dysphagia screening, discharge antiplatelets, lipid-lowering therapy, stroke education, and rehabilitation.
- The model demonstrated excellent discrimination (AUC=0.94) and calibration (p=0.63).
Conclusions:
- A validated prognostic model for predicting mortality after first-ever acute ischemic stroke was developed.
- The model shows excellent predictive performance and potential clinical utility in acute stroke care decision-making.
- Identified predictors can aid in developing risk calculators and informing clinical decisions for healthcare providers and patients.
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01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:15Ischemic Stroke ll: Pathophysiology
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A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...