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Published on: February 17, 2013
Internal Construct Assessment of the Perfusion Collateral Impairment Score: Component Independence and Outcomes
Shankar Biswas1, Hamza Adel Salim2, Derek A Tsang2
1From the Department of Internal Medicine (S.B.), Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine; Department of Neuroradiology (H.A.S., A.C.), Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins University School of Medicine (D.A.T., K.L.), Baltimore, MD, USA; Department of Neuroradiology (D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; Department of Neuroradiology (A.S.), University of Cincinnati, Cincinnati, OH, USA; Department of Neuroscience (V.V.), Renaissance School of Medicine, SUNY Stony Brook, Stony Brook, NY, USA; Department of Neuroradiology (G.S.), University of Michigan (Michigan Medicine), Ann Arbor, MI, USA; Department of Interventional Neuroradiology (A.G.), Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology and Neurosurgery (A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Stanford Stroke Center, Department of Neurology (G.W.A.), Radiology (J.J.H.), Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology (T.D.F.), University Hospitals Münster, Münster, Germany and Department of Radiology (V.S.Y.), Johns Hopkins University School of Medicine, Baltimore, MD, USA. Sb740927@gmail.com.
Insights
The Perfusion Collateral Impairment Score (PCIS) showed a small improvement in predicting outcomes for large vessel occlusion (LVO) stroke compared to its individual components. Further external validation is recommended for this stroke outcome prediction tool.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- The Perfusion Collateral Impairment Score (PCIS) is an ordinal composite score used in large vessel occlusion (LVO) stroke.
- PCIS combines hypoperfusion intensity ratio (HIR), cerebral blood volume index (CBVI), and prolonged venous transit (PVT+).
- PCIS has been associated with poor 90-day outcomes, but its superiority over individual components was untested.
Purpose of the Study:
- To compare the predictive performance of the ordinal Perfusion Collateral Impairment Score (PCIS) against its individual components.
- To evaluate whether PCIS offers superior outcome prediction in anterior circulation large vessel occlusion (LVO) stroke.
Main Methods:
- Analysis of 283 anterior circulation LVO patients from two stroke centers.
- DeLong testing compared ordinal PCIS with HIR, CBVI, and PVT+ for predicting unfavorable 90-day outcomes (modified Rankin Scale [mRS] 3-6).
- Tested for equivalence using TOST and performed calibration, reclassification, decision curve, and multivariable analyses.
Main Results:
- Ordinal PCIS demonstrated a numerically higher Area Under the Curve (AUC) of 0.61 compared to its components (AUC 0.56-0.57).
- The difference in AUC (ΔAUC) between PCIS and HIR/CBVI was 0.05 (P=0.04 uncorrected, P=0.13 with Bonferroni correction).
- PCIS showed good calibration and retained independent association with poor outcomes on multivariable adjustment (aOR 1.41).
Conclusions:
- Ordinal PCIS offers a marginal gain in predictive discrimination over its individual components for LVO stroke outcomes.
- The score exhibits good calibration but modest absolute discrimination.
- External validation is necessary to confirm the generalizability of these findings.
Background:
The Perfusion Collateral Impairment Score (PCIS), an ordinal composite (range 0-3) of hypoperfusion intensity ratio (HIR ≥ 0.4), cerebral blood volume index (CBVI < 0.8), and prolonged venous transit (PVT+), was associated with poor 90-day outcomes in large vessel occlusion (LVO) stroke. Whether it outperforms its components remains untested.
Methods:
We analyzed 283 anterior circulation LVO patients from two centers. Ordinal PCIS was compared with each component using DeLong testing for unfavorable outcome (modified Rankin Scale [mRS] 3-6) at 90 days, with Bonferroni correction (k = 3). Equivalence was tested by TOST (Δ = 0.10; sensitivity Δ = 0.05). Calibration, reclassification, decision curve analysis, multivariable adjustment, and subgroup analyses were performed.
Results:
Unfavorable outcome occurred in 148 (52.3%). Ordinal PCIS (AUC, 0.61) was numerically higher than HIR ≥ 0.4, CBVI < 0.8, and PVT+ (AUC 0.56-0.57); ΔAUC vs HIR and CBVI was 0.05 (P = 0.04 uncorrected; P = 0.13 Bonferroni). Components were equivalent at Δ = 0.10 but not Δ = 0.05; VIFs 1.31-1.72. Calibration was good (slope 1.00; Hosmer-Lemeshow P = 0.83). PCIS retained independent association on multivariable adjustment (aOR, 1.41; 95% CI, 1.03-1.92; P = 0.03).
Conclusions:
Ordinal PCIS showed marginal AUC gain over its components and good calibration. Absolute discrimination was modest; external validation is needed.
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