Kernan W N, Viscoli C M, Brass L M, Makuch R W, Sarrel P M, Roberts R S, Gent M, Rothwell P, Sacco R L, Liu R C, Boden-Albala B, Horwitz R I
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
Stroke. 2000 Feb;31(2):456-62. doi: 10.1161/01.str.31.2.456.
In 1991 we developed the Stroke Prognosis Instrument (SPI-I) to stratify patients with transient ischemic attack or ischemic stroke by prognosis for stroke or death in 2 years. In this article we validate and improve SPI-I (creating SPI-II).
To validate SPI-I, we applied it to 4 test cohorts and calculated pooled outcome rates. To create SPI-II, we incorporated new predictive variables identified in 1 of the test cohorts and validated it in the other 3 cohorts.
For SPI-I, pooled rates (all 4 test cohorts) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 24%, respectively (P<0.01, log-rank test). SPI-II was created by adding congestive heart failure and prior stroke to SPI-I. Each patient's risk group was determined by the total score for 7 factors: congestive heart failure (3 points); diabetes (3 points); prior stroke (3 points); age >70 years (2 points); stroke for the index event (not transient ischemic attack) (2 points); hypertension (1 point); and coronary artery disease (1 point). Risk groups I, II, and III comprised patients with 0 to 3, 4 to 7, and 8 to 15 points, respectively. For SPI-I, pooled rates (3 cohorts excluding the SPI-II development cohort) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 23%, respectively. For SPI-II, pooled rates were 10%, 19%, and 31%, respectively. In receiver operator characteristic analysis, the area under the curve was 0.59 (95% CI, 0.57 to 0.60) for SPI-I and 0.63 (95% CI, 0.62 to 0.65) for SPI-II, confirming the better performance of the latter.
Compared with SPI-I, SPI-II achieves greater discrimination in outcome rates among risk groups. SPI-II is ready for use in research design and may have a role in patient counseling.
1991年我们开发了卒中预后工具（SPI-I），用于根据2年内发生卒中或死亡的预后情况对短暂性脑缺血发作或缺血性卒中患者进行分层。在本文中，我们对SPI-I进行验证并改进（创建SPI-II）。
为验证SPI-I，我们将其应用于4个测试队列并计算合并结局发生率。为创建SPI-II，我们纳入了在其中一个测试队列中识别出的新预测变量，并在其他3个队列中对其进行验证。
对于SPI-I，I、II和III风险组2年内卒中或死亡的合并发生率（所有4个测试队列）分别为9%、17%和24%（P<0.01，对数秩检验）。SPI-II是通过在SPI-I中加入充血性心力衰竭和既往卒中而创建的。每位患者的风险组由7个因素的总分确定：充血性心力衰竭（3分）；糖尿病（3分）；既往卒中（3分）；年龄>70岁（2分）；索引事件为卒中（非短暂性脑缺血发作）（2分）；高血压（1分）；冠状动脉疾病（1分）。I、II和III风险组分别包括得分为0至3分、4至7分和8至15分的患者。对于SPI-I，I、II和III风险组2年内卒中或死亡的合并发生率（3个队列，不包括SPI-II开发队列）分别为9%、17%和23%。对于SPI-II，合并发生率分别为10%、19%和31%。在受试者工作特征分析中，SPI-I的曲线下面积为0.59（95%CI，0.57至0.60），SPI-II为0.63（95%CI，0.62至0.65），证实了后者具有更好的性能。
与SPI-I相比，SPI-II在风险组间结局发生率方面具有更大的区分度。SPI-II可用于研究设计，并可能在患者咨询中发挥作用。
