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Prediction of in-hospital stroke mortality in critical care unit.

Ho WM, Lin JR, Wang HH, Liou CW, Chang KC, Lee JD, Peng TY, Yang JT, Chang YJ, Chang CH, Lee TH - Springerplus (2016)

Bottom Line: In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality.Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.

View Article: PubMed Central - PubMed

Affiliation: Dementia Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC.

ABSTRACT

Background: Critical stroke causes high morbidity and mortality. We examined if variables in the early stage of critical stroke could predict in-hospital mortality.

Methods: We recruited 611 ischemic and 805 hemorrhagic stroke patients who were admitted within 24 h after the symptom onset. Data were analyzed with independent t test and Chi square test, and then with multivariate logistic regression analysis.

Results: In ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score (OR 1.08; 95 % CI 1.06-1.11; P < 0.01), white blood cell count (OR 1.11; 95 % CI 1.05-1.18; P < 0.01), systolic blood pressure (BP) (OR 0.49; 95 % CI 0.26-0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00-1.05; P = 0.03) were associated with in-hospital mortality. In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality. Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.

Conclusion: Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.

No MeSH data available.


Related in: MedlinePlus

Nomograms for risk prediction of in-hospital mortality in acute stroke. a Nomogram for ischemic stroke, b nomogram for hemorrhagic stroke. For clinical use of nomogram, physicians first put data onto each scale of variables and then align vertically to the above point axis to get points. Then, sum up the points of each variable to obtain the final score and convert the score into probability of mortality. Due to the U-shape distribution, systolic BP was categorized into Group 1 with systolic BPs <100 or >180 mmHg and Group 2 with systolic BPs between 100 and 180 mmHg. BUN/Cr ratio blood urea nitrogen to creatinine ratio, NIHSS National Institutes of Health Stroke Scale, SBP systolic blood pressure, WBC white blood cell
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Fig3: Nomograms for risk prediction of in-hospital mortality in acute stroke. a Nomogram for ischemic stroke, b nomogram for hemorrhagic stroke. For clinical use of nomogram, physicians first put data onto each scale of variables and then align vertically to the above point axis to get points. Then, sum up the points of each variable to obtain the final score and convert the score into probability of mortality. Due to the U-shape distribution, systolic BP was categorized into Group 1 with systolic BPs <100 or >180 mmHg and Group 2 with systolic BPs between 100 and 180 mmHg. BUN/Cr ratio blood urea nitrogen to creatinine ratio, NIHSS National Institutes of Health Stroke Scale, SBP systolic blood pressure, WBC white blood cell

Mentions: Significant variables in univariate analysis were assigned to build up multivariate logistic regression model. In ischemic stroke group, age, gender, NIHSS score, WBC count, BUN and BUN/Cr ratio were chosen as covariates. The systolic BP was added under the consideration of clinical importance. Multivariate analysis (Table 2) showed NIHSS score (OR 1.08; 95 % CI 1.06–1.11; P < 0.01), WBC count (OR 1.11; 95 % CI 1.05–1.18; P < 0.01), systolic BP (OR 0.49; 95 % CI 0.26–0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00–1.05; P = 0.03) were significantly associated with in-hospital mortality, while BUN/Cr ratio was not. Fitness of the predictive model (Fig. 2a) was well calibrated (Z = 0.65, P = 0.52) with mild overestimation in high risk patients. Discriminative examination showed c-statistic = 0.79. In conversion to nomogram (Fig. 3a), NIHSS score was assigned to be 100 points and the rest of the variables were appointed in proportion to their beta coefficients.Table 2


Prediction of in-hospital stroke mortality in critical care unit.

Ho WM, Lin JR, Wang HH, Liou CW, Chang KC, Lee JD, Peng TY, Yang JT, Chang YJ, Chang CH, Lee TH - Springerplus (2016)

Nomograms for risk prediction of in-hospital mortality in acute stroke. a Nomogram for ischemic stroke, b nomogram for hemorrhagic stroke. For clinical use of nomogram, physicians first put data onto each scale of variables and then align vertically to the above point axis to get points. Then, sum up the points of each variable to obtain the final score and convert the score into probability of mortality. Due to the U-shape distribution, systolic BP was categorized into Group 1 with systolic BPs <100 or >180 mmHg and Group 2 with systolic BPs between 100 and 180 mmHg. BUN/Cr ratio blood urea nitrogen to creatinine ratio, NIHSS National Institutes of Health Stroke Scale, SBP systolic blood pressure, WBC white blood cell
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940351&req=5

Fig3: Nomograms for risk prediction of in-hospital mortality in acute stroke. a Nomogram for ischemic stroke, b nomogram for hemorrhagic stroke. For clinical use of nomogram, physicians first put data onto each scale of variables and then align vertically to the above point axis to get points. Then, sum up the points of each variable to obtain the final score and convert the score into probability of mortality. Due to the U-shape distribution, systolic BP was categorized into Group 1 with systolic BPs <100 or >180 mmHg and Group 2 with systolic BPs between 100 and 180 mmHg. BUN/Cr ratio blood urea nitrogen to creatinine ratio, NIHSS National Institutes of Health Stroke Scale, SBP systolic blood pressure, WBC white blood cell
Mentions: Significant variables in univariate analysis were assigned to build up multivariate logistic regression model. In ischemic stroke group, age, gender, NIHSS score, WBC count, BUN and BUN/Cr ratio were chosen as covariates. The systolic BP was added under the consideration of clinical importance. Multivariate analysis (Table 2) showed NIHSS score (OR 1.08; 95 % CI 1.06–1.11; P < 0.01), WBC count (OR 1.11; 95 % CI 1.05–1.18; P < 0.01), systolic BP (OR 0.49; 95 % CI 0.26–0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00–1.05; P = 0.03) were significantly associated with in-hospital mortality, while BUN/Cr ratio was not. Fitness of the predictive model (Fig. 2a) was well calibrated (Z = 0.65, P = 0.52) with mild overestimation in high risk patients. Discriminative examination showed c-statistic = 0.79. In conversion to nomogram (Fig. 3a), NIHSS score was assigned to be 100 points and the rest of the variables were appointed in proportion to their beta coefficients.Table 2

Bottom Line: In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality.Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.

View Article: PubMed Central - PubMed

Affiliation: Dementia Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC.

ABSTRACT

Background: Critical stroke causes high morbidity and mortality. We examined if variables in the early stage of critical stroke could predict in-hospital mortality.

Methods: We recruited 611 ischemic and 805 hemorrhagic stroke patients who were admitted within 24 h after the symptom onset. Data were analyzed with independent t test and Chi square test, and then with multivariate logistic regression analysis.

Results: In ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score (OR 1.08; 95 % CI 1.06-1.11; P < 0.01), white blood cell count (OR 1.11; 95 % CI 1.05-1.18; P < 0.01), systolic blood pressure (BP) (OR 0.49; 95 % CI 0.26-0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00-1.05; P = 0.03) were associated with in-hospital mortality. In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality. Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.

Conclusion: Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.

No MeSH data available.


Related in: MedlinePlus