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Puntuación de riesgo para la mortalidad por accidente cerebrovascular isquémico en el hospital derivada y validada
Eric E Smith1, Nandavar Shobha, David Dai
1Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. eesmith@ucalgary.ca
Circulation
|September 30, 2010
Resumen
Un nuevo modelo de riesgo que utiliza los datos de Get With the Guidelines-Stroke ayuda a predecir las muertes en el hospital después de un accidente cerebrovascular isquémico. El puntaje de la Escala de Accidentes Cerebrovasculares de los Institutos Nacionales de la Salud (NIHSS, por sus siglas en inglés) es un fuerte predictor de la mortalidad.
Área de la Ciencia:
- Neurología Neurología.
- Cardiología Cardiología.
- Salud Pública La salud pública.
Sus antecedentes:
- Los modelos validados para predecir la mortalidad hospitalaria después de un accidente cerebrovascular isquémico son escasos.
- La base de datos Get With the Guidelines-Stroke Program fue utilizada para desarrollar y validar tales modelos.
Objetivo del estudio:
- Para derivar y validar modelos de predicción para el riesgo de mortalidad en el hospital en pacientes con accidente cerebrovascular isquémico.
- Evaluar la utilidad de la puntuación de la Escala de Accidentes Cerebrovasculares de los Institutos Nacionales de la Salud (NIHSS) en la predicción de la mortalidad.
Principales métodos:
- Se utilizaron datos de 274.988 pacientes con accidente cerebrovascular isquémico del programa Get With the Guidelines-Stroke (2001-2007).Los datos fueron obtenidos a partir de los datos de 274.988 pacientes con accidente cerebrovascular isquémico del programa Get With the Guidelines-Stroke (2001-2007).Los datos fueron obtenidos a partir de los datos de 274.988 pacientes con accidente cerebrovascular isquémico.
- Empleó regresión logística para identificar predictores independientes de mortalidad y crear un modelo de predicción.
- Valida el modelo en una muestra separada y específicamente en pacientes con puntuaciones registradas de NIHSS.
Principales resultados:
- En general, la mortalidad hospitalaria fue del 5,5%.
- El modelo de predicción derivado demostró una buena discriminación (C estadístico 0,72 en la muestra de validación general).
- Un modelo que incorpora el puntaje de NIHSS logró una mayor discriminación (estadística C 0.85), con NIHSS solo mostrando un fuerte poder predictivo (estadística C 0.83).
Conclusiones:
- El modelo de riesgo de accidente cerebrovascular Get With the Guidelines es una herramienta validada y práctica para la estratificación del riesgo de mortalidad en cama.
- La puntuación del NIHSS es un predictor crucial, mejorando significativamente la evaluación del riesgo de mortalidad a corto plazo en pacientes con accidente cerebrovascular isquémico.
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