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dc.contributor.authorSzlachetka, Weronika A
dc.contributor.authorPana, Tiberiu A
dc.contributor.authorMamas, Mamas A
dc.contributor.authorBettencourt-Silva, Joao H
dc.contributor.authorMetcalf, Anthony K
dc.contributor.authorPotter, John F
dc.contributor.authorMcLernon, David J
dc.contributor.authorMyint, Phyo K
dc.date.accessioned2022-06-07T08:16:34Z
dc.date.available2022-06-07T08:16:34Z
dc.date.issued2022-06
dc.date.submitted2021-04-18
dc.identifier.issn0300-9009
dc.identifier.others13760-021-01752-9
dc.identifier.other1752
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/337833
dc.description.abstractPredicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96-9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62-3.14), eGFR < 15 (1.97, 1.55-2.52), 1-year increment in age (1.04, 1.04-1.05), liver disease (1.50, 1.20-1.87), peripheral vascular disease (1.39, 1.23-1.57), cancers (1.37, 1.27-1.47), heart failure (1.24, 1.15-1.34), 1-point increment in pre-stroke mRS (1.20, 1.17-1.22), atrial fibrillation (1.17, 1.10-1.24), coronary heart disease (1.09, 1.02-1.16), chronic obstructive pulmonary disease (1.13, 1.03-1.25) and hypertension (0.77, 0.72-0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.
dc.languageen
dc.publisherSpringer Science and Business Media LLC
dc.subjectOriginal Article
dc.subjectIschaemic stroke
dc.subjectLong-term mortality
dc.subjectPrediction score
dc.subjectPrognosis
dc.subjectCerebrovascular disease
dc.titlePredicting 10-year stroke mortality: development and validation of a nomogram.
dc.typeArticle
dc.date.updated2022-06-07T08:16:33Z
prism.endingPage693
prism.issueIdentifier3
prism.publicationNameActa Neurol Belg
prism.startingPage685
prism.volume122
dc.identifier.doi10.17863/CAM.85242
dcterms.dateAccepted2021-07-12
rioxxterms.versionofrecord10.1007/s13760-021-01752-9
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidSzlachetka, Weronika A [0000-0002-2465-029X]
dc.contributor.orcidMyint, Phyo K [0000-0003-3852-6158]
dc.identifier.eissn2240-2993
pubs.funder-project-idMedical Research Scotland (VAC-1424-2019)
cam.issuedOnline2021-08-18


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