Abstract
Background
Although sleep apnea and peripheral artery disease are prognostic factors for stroke,
their added benefit in the acute stage to further prognosticate strokes has not been
evaluated.
Objectives
We tested the accuracy in the acute stroke stage of a novel score called the Non-Invasive
Prognostic Stroke Scale (NIPSS).
Patients and methods
Prospective cohort with imaging-confirmed ischemic stroke. Clinical data, sleep apnea
risk score (STOPBANG) and blood pressure measures were collected at baseline. Primary
outcome was the 90-day modified Rankin Scale (mRS), with poor outcome defined as mRS
3-6. Area under the ROC curve (AUC) was calculated for NIPSS and compared to six other
stroke prognostic scores in our cohort: SPAN-100 index, S-SMART, SOAR, ASTRAL, THRIVE,
and Dutch Stroke scores.
Results
We enrolled 386 participants. After 90 days, there were 56% with poor outcome, more
frequently older, female predominant and with higher admission National Institute
of Health Stroke Scale (NIHSS). Four variables remained significantly associated with
primary endpoint in the multivariable model: age (OR 1.87), NIHSS (OR 7.08), STOPBANG
category (OR 1.61), and ankle-braquial index (OR 2.11). NIPSS AUC was 0.86 (0.82–0.89);
0.83 (0.79-0.87) with bootstrapping. When compared to the other scores, NIPSS, ASTRAL,
S-SMART and DUTCH scores had good abilities in predicting poor outcome, with AUC of
0.86, 0.86, 0.83 and 0.82, respectively. THRIVE, SOAR and SPAN-100 scores were fairly
predictive.
Discussion and conclusions
Non-invasive and easily acquired emergency room data can predict clinical outcome
after stroke. NIPSS performed equal to or better than other prognostic stroke scales.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global burden of cardiovascular diseases and risk factors 1990–2019.J Am Coll Cardiol. 2020; 76 (vn): 2982-3021
- Prevalence of stroke and associated disability in Brazil: National Health Survey 2013.Arq Neuropsiquiatr. 2015; 73 (vn): 746-750
- Predicting functional outcome based on linked data after acute ischemic stroke: S-SMART score.Transl Stroke Res. 2020; 11 (vn): 1296-1305
- Development and validation of the Dutch Stroke Score for predicting disability and functional outcome after ischemic stroke: a tool to support efficient discharge planning.Eur Stroke J. 2018; 3 (vn): 165-173
- An integer-based score to predict functional outcome in acute ischemic stroke: The ASTRAL score.Neurology. 2012; 78 (vn): 1916-1922
- Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score.Am J Neuroradiol. 2010; 31 (vn): 1192-1196
- Stroke prognostication using age and NIH stroke scale: SPAN-100.Neurology. 2013; 80 (vn): 21-28
- The SOAR (stroke subtype, oxford community stroke project classification, age, prestroke modified rankin) score strongly predicts early outcomes in acute stroke.Int J Stroke. 2014; 9 (vn): 278-283
- Stroke prognostic scores and data-driven prediction of clinical outcomes after acute ischemic stroke.Stroke. 2020; 51 (vn): 1477-1483
- Stop questionnaire: a tool to screen patients for obstructive sleep apnea.Anesthesiology. 2008; 108: 812-821
- Validation of a Portuguese version of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea: analysis in a sleep clinic.J Bras Pneumol. 2017; 21: 61-68
- Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis.Stroke. 2007; 38: 1091-1096
- Validation of a structured interview for telephone assessment of the modified Rankin Scale in Brazilian stroke patients.Cerebrovasc Dis. 2014; 38: 297-301
- Validation of the national institutes of health stroke scale, modified Rankin scale and barthel index in Brazil: the role of cultural adaptation and structured interviewing.Cerebrovasc Dis. 2009; 27: 119-122
- Epidemiology of sleep apnoea/hypopnoea syndrome and sleep disordered breathing.Eur Respir J. 2009; 33: 907-914
- Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of sleep medicine task force.Sleep. 1999; 22: 667-689
- Obstructive sleep apnea as a risk factor for stroke and death.N Engl J Med. 2005; 353: 2034-2041
- Association of sleep-disordered breathing and the occurrence of stroke.Am J Respir Crit Care Med. 2005; 172: 1447-1451
- Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study.Am J Respir Crit Care Med. 2010; 182: 269-277
- Obstructive sleep apnea and risk of stroke: a meta-analysis of prospective studies.Int J Cardiol. 2014; 172: 466-469
- Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims.J Neurol. 2005; 252: 1394-1398
- SAS Care 1: sleep-disordered breathing in acute stroke an transient ischaemic attack - prevalence, evolution and association with functional outcome at 3 months, a prospective observational polysomnography study.ERJ. 2020; 6: 00334-02019
- Relationship of sleep apnea to functional capacity and length of hospitalization following stroke.Sleep. 2003; 26: 293-297
- Sleep disordered breathing among acute ischemic stroke patients in Brazil.Sleep Med. 2016; 19: 8-12
- 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines.Circulation. 2017; 135
- A propensity-matched study of the association of peripheral arterial disease with cardiovascular outcomes in community-dwelling older adults.Am J Cardiol. 2009; 103: 130-135
- Ankle-brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort.BMC Cardiovasc Disord. 2013; 13: 119
- Validation of the Totaled health risks in vascular events (THRIVE) score for outcome prediction in endovascular stroke treatment.Int J Stroke. 2014; 9: 32-39
- Performance of four ischemic stroke prognostic scores in a Brazilian population.Arq Neuropsiquiatr. 2016; 74: 133-137
- The totaled health risks in vascular events (THRIVE) score predicts ischemic stroke outcomes independent of thrombolytic therapy in the NINDS tPA trial.J Stroke Cerebrovasc Dis. 2013; 22 (pp): 1111-1116
- Totaled health risks in vascular events score predicts clinical outcome and symptomatic intracranial hemorrhage in chinese patients after thrombolysis.Stroke. 2015; 46: 864-866
- The SOAR stroke score predicts inpatient and 7-day mortality in acute stroke.Stroke. 2013; 44: 2010-2012
- Validation of the mSOAR and SOAR scores to predict early mortality in Chinese acute stroke patients.PLoS One. 2017; 12e0180444
- VISTA-Acute Collaboration Steering Committee. A simple risk index and thrombolytic treatment response in acute ischemic stroke.JAMA Neurol. 2014; 71: 848-854
- Study of risk factors associated with peripheral arteriopathy in japanese-brazilians from bauru (SP).Arq Bras Cardiol. 2014; 102 (Feb): 143-150
- Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil Arq.Bras Cardiol. 2008; 91
Article info
Publication history
Published online: November 23, 2022
Accepted:
October 17,
2022
Received in revised form:
October 7,
2022
Received:
April 29,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106864
Copyright
© 2022 Elsevier Inc. All rights reserved.
