Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study
ABSTRACT Background and Aims There is a lack of population‐based studies focusing on guideline‐based prognostic models for stroke. This study aimed to develop and validate a prognostic model that predicts mortality following a first‐ever acute ischemic stroke. Methods The study included 899 adult pa...
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Wiley
2025-02-01
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| Series: | Health Science Reports |
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| Online Access: | https://doi.org/10.1002/hsr2.70445 |
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| author | Mustapha Mohammed Hadzliana Zainal Siew Chin Ong Balamurugan Tangiisuran Fatimatuzzahra Abdul Aziz Norsima N. Sidek Abubakar Sha'aban Umar Idris Ibrahim Surajuddeen Muhammad Irene Looi Zariah A. Aziz |
| author_facet | Mustapha Mohammed Hadzliana Zainal Siew Chin Ong Balamurugan Tangiisuran Fatimatuzzahra Abdul Aziz Norsima N. Sidek Abubakar Sha'aban Umar Idris Ibrahim Surajuddeen Muhammad Irene Looi Zariah A. Aziz |
| author_sort | Mustapha Mohammed |
| collection | DOAJ |
| description | ABSTRACT Background and Aims There is a lack of population‐based studies focusing on guideline‐based prognostic models for stroke. This study aimed to develop and validate a prognostic model that predicts mortality following a first‐ever acute ischemic stroke. Methods The study included 899 adult patients ( ≥ 18 years) with confirmed diagnosis of first‐ever acute ischemic stroke enrolled in the Malaysian National Stroke Registry (NSR) from January 2009 to December 2019. The primary outcome was mortality within 90 days post‐stroke (266 events [29.6%]). The prognostic model was developed using logistic regression (75%, n = 674) and internally validated (25%, n = 225). Model performance was assessed using discrimination (area under the curve (AUC]) and calibration (Hosmer‐Lemeshow test [HL]). Results The final model includes factors associated with increased risk of mortality, such as age (adjusted odds ratio, aOR 1.06 [95% confidence interval, CI 1.03, 1.10; p < 0.001]), National Institutes of Health Stroke Scale (NIHSS) score aOR 1.08 (95% CI 1.08, 1.13; p = 0.004), and diabetes aOR 2.29 (95% CI 1.20, 4.37; p = 0.012). The protective factors were antiplatelet within 48 h. aOR 0.40 (95% CI 0.19, 0.81; p = 0.01), dysphagia screening aOR 0.30 (95% CI 0.15, 0.61; p = 0.001), antiplatelets upon discharge aOR 0.17 (95% CI 0.08, 0.35; p < 0.001), lipid‐lowering therapy aOR 0.37 (95% CI 0.17, 0.82; p = 0.01), stroke education aOR 0.02 (95% CI 0.01, 0.05; p < 0.001) and rehabilitation aOR 0.08 (95% CI 0.04, 0.16; p < 0.001). The model demonstrated excellent performance (discrimination [AUC = 0.94] and calibration [HL, X2 p = 0.63]). Conclusion The study developed a validated prognostic model that excellently predicts mortality after a first‐ever acute ischemic stroke with potential clinical utility in acute stroke care decision‐making. The predictors could be valuable for creating risk calculators and aiding healthcare providers and patients in making well‐informed clinical decisions during the stroke care process. |
| format | Article |
| id | doaj-art-4bae919b5b9647cca84df6b63ae95f43 |
| institution | OA Journals |
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| language | English |
| publishDate | 2025-02-01 |
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| spelling | doaj-art-4bae919b5b9647cca84df6b63ae95f432025-08-20T02:11:08ZengWileyHealth Science Reports2398-88352025-02-0182n/an/a10.1002/hsr2.70445Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort StudyMustapha Mohammed0Hadzliana Zainal1Siew Chin Ong2Balamurugan Tangiisuran3Fatimatuzzahra Abdul Aziz4Norsima N. Sidek5Abubakar Sha'aban6Umar Idris Ibrahim7Surajuddeen Muhammad8Irene Looi9Zariah A. Aziz10QU Health Qatar University Doha QatarSchool of Pharmaceutical Sciences Universiti Sains Malaysia Pulau Pinang MalaysiaSchool of Pharmaceutical Sciences Universiti Sains Malaysia Pulau Pinang MalaysiaSchool of Pharmaceutical Sciences Universiti Sains Malaysia Pulau Pinang MalaysiaSchool of Pharmaceutical Sciences Universiti Sains Malaysia Pulau Pinang MalaysiaClinical Research Center Hospital Sultanah Nur Zahirah Terengganu MalaysiaDivision of Population Medicine Cardiff University Cardiff WalesFaculty of Pharmacy Universiti Sultan Zainal Abidin Kuala Terengganu MalaysiaFaculty of Veterinary Medicine Ahmadu Bello University Kaduna NigeriaClinical Research Center Hospital Seberang Jaya Pulau Pinang MalaysiaClinical Research Center Hospital Sultanah Nur Zahirah Terengganu MalaysiaABSTRACT Background and Aims There is a lack of population‐based studies focusing on guideline‐based prognostic models for stroke. This study aimed to develop and validate a prognostic model that predicts mortality following a first‐ever acute ischemic stroke. Methods The study included 899 adult patients ( ≥ 18 years) with confirmed diagnosis of first‐ever acute ischemic stroke enrolled in the Malaysian National Stroke Registry (NSR) from January 2009 to December 2019. The primary outcome was mortality within 90 days post‐stroke (266 events [29.6%]). The prognostic model was developed using logistic regression (75%, n = 674) and internally validated (25%, n = 225). Model performance was assessed using discrimination (area under the curve (AUC]) and calibration (Hosmer‐Lemeshow test [HL]). Results The final model includes factors associated with increased risk of mortality, such as age (adjusted odds ratio, aOR 1.06 [95% confidence interval, CI 1.03, 1.10; p < 0.001]), National Institutes of Health Stroke Scale (NIHSS) score aOR 1.08 (95% CI 1.08, 1.13; p = 0.004), and diabetes aOR 2.29 (95% CI 1.20, 4.37; p = 0.012). The protective factors were antiplatelet within 48 h. aOR 0.40 (95% CI 0.19, 0.81; p = 0.01), dysphagia screening aOR 0.30 (95% CI 0.15, 0.61; p = 0.001), antiplatelets upon discharge aOR 0.17 (95% CI 0.08, 0.35; p < 0.001), lipid‐lowering therapy aOR 0.37 (95% CI 0.17, 0.82; p = 0.01), stroke education aOR 0.02 (95% CI 0.01, 0.05; p < 0.001) and rehabilitation aOR 0.08 (95% CI 0.04, 0.16; p < 0.001). The model demonstrated excellent performance (discrimination [AUC = 0.94] and calibration [HL, X2 p = 0.63]). Conclusion The study developed a validated prognostic model that excellently predicts mortality after a first‐ever acute ischemic stroke with potential clinical utility in acute stroke care decision‐making. The predictors could be valuable for creating risk calculators and aiding healthcare providers and patients in making well‐informed clinical decisions during the stroke care process.https://doi.org/10.1002/hsr2.70445acute ischemic strokecalibrationdiscriminationmortalityprognostic modelvalidation |
| spellingShingle | Mustapha Mohammed Hadzliana Zainal Siew Chin Ong Balamurugan Tangiisuran Fatimatuzzahra Abdul Aziz Norsima N. Sidek Abubakar Sha'aban Umar Idris Ibrahim Surajuddeen Muhammad Irene Looi Zariah A. Aziz Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study Health Science Reports acute ischemic stroke calibration discrimination mortality prognostic model validation |
| title | Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study |
| title_full | Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study |
| title_fullStr | Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study |
| title_full_unstemmed | Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study |
| title_short | Prognostic Models of Mortality Following First‐Ever Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study |
| title_sort | prognostic models of mortality following first ever acute ischemic stroke a population based retrospective cohort study |
| topic | acute ischemic stroke calibration discrimination mortality prognostic model validation |
| url | https://doi.org/10.1002/hsr2.70445 |
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