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Updated: Mar 31, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Performance of Modified NIHSS and APUA Scores in Predicting in-Hospital Mortality and Functional Outcome in Acute
Ibrahim Altundag1, Fatih Sorgun1, Metin Oner1
1University of Health Sciences Turkiye, Haydarpasa Numune Training and Research Hospital, Clinic of Emergency Medicine, Istanbul, Türkiye.
Objective:
Outcome prediction in acute ischemic stroke (AIS) remains complex due to numerous clinical and laboratory factors. The modified National Institutes of Health Stroke Scale (mNIHSS) is widely used to assess neurological severity, while the age, pulse, urea, albumin (APUA) score has shown potential for predicting mortality in other acute conditions. This study aimed to evaluate the performance of mNIHSS and APUA scores in predicting in-hospital mortality and poor functional outcome in AIS.
Methods:
This retrospective cohort study included adults presenting with AIS between January 2020 and January 2025. Initial mNIHSS and APUA scores were calculated. Outcomes included in-hospital mortality and poor functional status, defined as an modified Rankin Scale (mRS) score of 3-6 at discharge. Diagnostic performance was assessed using receiver operating characteristic analysis, and area under the curves (AUCs) were compared using the DeLong test.
Results:
Among 491 patients, 21 (4.3%) died during hospitalization, and 66 (13.4%) had poor functional outcomes. Both scores predicted mortality effectively (AUC: mNIHSS 0.752 vs. APUA 0.791, p=0.150), with optimal cut-offs (mNIHSS ≥6, APUA ≥4) yielding 61.9% sensitivity and >91% specificity. In predicting poor functional outcome, mNIHSS showed significantly greater accuracy (AUC: 0.822 vs. 0.689, p=0.007) and higher sensitivity (68.7% vs. 35.8%). A strong correlation existed between initial mNIHSS and discharge mRS (p<0.001).
Conclusions:
This study provides the first retrospective assessment of the performance of the APUA score in AIS patients. Both scores effectively predict in-hospital mortality, while mNIHSS better predicts functional outcomes. Combined use of these complementary scores may enhance risk stratification and patient management in AIS care.
