Post-stroke sequelae risk score (PSSRS): a 16-year retrospective study developing an internally validated multi-algorithm model for post-stroke sequelae
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Yiqun Dong1, Rongji Lu1, Yuying Zhang1
1Department of Cerebrovascular Surgery, Neurosurgery Center, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, The National Key Clinical Specialty, Southern Medical University, Guangzhou, China.
Introduction:
Post-stroke sequelae (PSS) encompass persistent functional impairments after stroke and may benefit from early risk stratification. We developed and internally validated a time-to-event prediction model based on routinely available clinical and biochemical variables.
Method:
This retrospective single-center cohort included 2,095 patients hospitalized with acute stroke at Zhujiang Hospital between 2008 and 2024. Thirty-seven candidate variables were assessed. The cohort was split 7:3 into training (n = 1,467) and internal test (n = 628) sets before preprocessing, feature selection, tuning, and model comparison. Univariate Cox, multivariable Cox, least absolute shrinkage and selection operator (LASSO), and random survival forest (RSF) analyses identified eight intersection variables. A total of 101 survival-model pipelines were compared using training-set resampling; the selected model was then evaluated in the internal test set.
Result:
The StepCox (forward) + RSF pipeline showed the highest prespecified training-resampling performance. Its Harrell C-index was 0.87 in the training set and 0.85 in the internal test set. Test-set time-dependent AUROCs at 1, 3, and 5 years were 0.800 (95% CI, 0.760-0.840), 0.830 (0.790-0.870), and 0.820 (0.780-0.860), respectively; corresponding AUPRCs were 0.748, 0.772, and 0.761, and Brier scores were 0.140, 0.170, and 0.180. Calibration slopes were 0.96, 0.93, and 0.90. LDH, CK-MB, and DBIL were among the leading contributors in the model-interpretation analyses.
Conclusion:
PSSRS provides an internally validated framework for estimating individualized risk of post-stroke sequelae. External temporal and multicenter validation is required before clinical implementation.