Baseline NIH Stroke Scale score strongly predicts outcome after stroke

Adams, Harold P.; Davis, Patricia H.; Leira, Enrique C.; Chang, Ku‐Chou; Bendixen, Birgitte H.; Clarke, William R.; Woolson, Robert F.; Hansen, Michael D.

doi:10.1212/wnl.53.1.126

Cited by 1,170 publications

(796 citation statements)

References 32 publications

(10 reference statements)

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“…sST2 may be a marker for stroke‐induced cardiac injury, which in turn, influences subsequent neurological outcome after stroke. Alternatively, it is possible that sST2 may integrate both stroke severity and cardiovascular disease, each of which is strongly associated with outcome after stroke 28, 29, 30. Although our current data cannot exclude these possibilities, our multivariable models adjusting for cardiovascular risk factors and stroke severity suggest that sST2 is independent from these factors.…”

Section: Discussionmentioning

confidence: 66%

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

Wolcott

Batra

Bevers

et al. 2017

Ann Clin Transl Neurol

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Objective ST2 is a member of the toll‐like receptor superfamily that can alter inflammatory signaling of helper T‐cells. We investigated whether soluble ST2 (sST2) could independently predict outcome and hemorrhagic transformation (HT) in the setting of stroke.MethodsWe measured sST2 in patients enrolled in the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) network biomarker study. 646 patients had plasma samples collected at the time of hospital admission and 210 patients had a second sample collected 48 h after stroke onset. Functional outcome was assessed using the modified Rankin Scale (mRS), with good and poor outcomes defined as mRS 0‐2 and 3‐6, respectively. HT was classified using ECASS criteria. The relationships between sST2, outcome, and HT were evaluated using multivariable logistic regression, Kaplan–Meier survival analysis and receiver operating characteristic curves.Results646 patients were included in the analysis (mean age 69 years; 44% women), with a median NIHSS of 5 [IQR: 2–12]. The median sST2 level on hospital admission was 35.0 ng/mL [IQR: 25.7–49.8 ng/mL] and at 48 h it was 37.4 ng/mL [IQR 27.9–55.6 ng/mL]. sST2 was independently associated with poor outcome (OR: 2.77, 95% CI: 1.54–5.06; P = 0.003) and mortality (OR: 3.56, 95% CI: 1.58–8.38, P = 0.001) after multivariable adjustment. Plasma sST2 was also associated with hemorrhagic transformation after adjustment for traditional risk factors (OR: 5.58, 95% CI: 1.40–37.44, P = 0.039).InterpretationSoluble ST2 may serve as a prognostic biomarker for outcome and hemorrhagic transformation in patients with acute stroke. ST2 may link neuroinflammation and secondary injury after stroke.

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Section: Discussionmentioning

confidence: 66%

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

Wolcott

Batra

Bevers

et al. 2017

Ann Clin Transl Neurol

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“…ESD, early supported discharge; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; CT, Computerised Tomography; MR, Magnetic Resonance Imaging; TOAST, Trial of Org 10172 in Acute Stroke Treatment4; MMSE, Mini Mental State Examination. a Comparison between completers and dropouts, statistical tests: χ2‐test, t ‐test, Mann–Whitney U ‐test or Fisher's exact test as appropriate; *some data are missing; # Likert scale 0–3. P ‐values ≤.05 indicated in bold.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Twenty of the variables were dichotomous, while some were ordinal ( previous smoking, estimated mRS before the stroke, Barthel Index at stable baseline, National Institutes of Health Stroke Scale [NIHSS] at stable baseline ), some continuous ( age, subjective health complaints prestroke, MMSE score at baseline) and some categorical ( location of lesion, TOAST‐classification, 4 randomisation group ).…”

Section: Methodsmentioning

confidence: 99%

“…The degree of disability and reduced functional capacity after stroke is aetiologically multifactorial. The severity of the initial neurologic affection has been established as a main determinant, and some other variables as sex, age, previous cerebrovascular disease and previous peripheral artery disease are frequently reported to be important predictors,3, 4, 5, 6, 7, 8, 9 but more specific knowledge about other possible predictive factors is needed in order to optimise stroke outcome.…”

Section: Introductionmentioning

confidence: 99%

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Subjective health complaints predict functional outcome six months after stroke

et al. 2016

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ObjectivesCerebrovascular stroke is a main cause of lasting disability in older age, and initial stroke severity has been established as a main determinant for the degree of functional loss. In this study, we searched for other predictors of functional outcome in a cohort of stroke patients participating in an early supported discharge randomised controlled trial.MethodsThirty candidate variables related either to premorbid history or to the acute stroke were examined by ordered logistic regression in 229 stroke patients. Dependent variables were modified Rankin Scale (mRS) at 6 months and mRS change from baseline to 6 months.ResultsFor mRS at 6 months, Barthel Index at stable baseline post‐stroke was the main predictor, with sex, age, previous cerebrovascular disease, previous peripheral artery disease and the necessity for tube feeding in the acute phase also contributing to the final model. For mRS change, only age and previous cerebrovascular disease were significant predictors. Prestroke subjective health complaints added significantly to all final models concurrently with sex losing its predictive power.ConclusionsInitial stroke severity was the main predictor of functional outcome. Subjective health complaints score was a potent predictor for both outcome and improvement from baseline to 6 months and at the same time ameliorated the predictive impact of sex. The poorer functional prognosis for women after stroke may therefore be related to their higher load of subjective health complaints rather than to their sex itself. Treating these complaints may possibly improve the functional prognosis.

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