Department of Medicine, University of Thessaly, Biopolis 41110, Larissa, Greece.
Stroke. 2013 Jun;44(6):1616-20. doi: 10.1161/STROKEAHA.113.001047. Epub 2013 Apr 4.
The ASTRAL score was externally validated showing remarkable consistency on 3-month outcome prognosis in patients with acute ischemic stroke. The present study aimed to evaluate ASTRAL score's prognostic accuracy to predict 5-year outcome.
All consecutive patients with acute ischemic stroke registered in the Athens Stroke Registry between January 1, 1998, and December 31, 2010, were included. Patients were excluded if admitted >24 hours after symptom onset or if any ASTRAL score component was missing. End points were 5-year unfavorable functional outcome, defined as modified Rankin Scale 3 to 6, and 5-year mortality. For each outcome, the area under the receiver operating characteristics curve was calculated; also, a multivariate Cox proportional hazards analysis was performed to investigate whether the ASTRAL score was an independent predictor of outcome. The Kaplan-Meier product limit method was used to estimate the probability of 5-year survival for each ASTRAL score quartile.
The area under the receiver operating characteristics curve of the score to predict 5-year unfavorable functional outcome was 0.89, 95% confidence interval 0.88 to 0.91. In multivariate Cox proportional hazards analysis, the ASTRAL score was independently associated with 5-year unfavorable functional outcome (hazard ratio, 1.09; 95% confidence interval, 1.08-1.10). The area under the receiver operating characteristics curve for the ASTRAL score's discriminatory power to predict 5-year mortality was 0.81 (95% confidence interval, 0.78-0.83). In multivariate analysis, the ASTRAL score was independently associated with 5-year mortality (hazard ratio, 1.09, 95% confidence interval, 1.08-1.10). During the 5-year follow-up, the probability of survival was significantly lower with increasing ASTRAL score quartiles (log-rank test <0.001).
The ASTRAL score reliably predicts 5-year functional outcome and mortality in patients with acute ischemic stroke.
ASTRAL 评分在预测急性缺血性脑卒中患者 3 个月预后方面得到了外部验证，具有显著的一致性。本研究旨在评估 ASTRAL 评分对预测 5 年预后的准确性。
纳入 1998 年 1 月 1 日至 2010 年 12 月 31 日期间在雅典卒中登记处连续登记的所有急性缺血性脑卒中患者。如果患者在发病后 24 小时以上入院或任何 ASTRAL 评分项目缺失，则将其排除在外。终点为 5 年不良功能结局（改良 Rankin 量表 3 至 6 分）和 5 年死亡率。计算每个结局的受试者工作特征曲线下面积；还进行了多变量 Cox 比例风险分析，以探讨 ASTRAL 评分是否为结局的独立预测因素。采用 Kaplan-Meier 乘积限法估计每个 ASTRAL 评分四分位数的 5 年生存率。
评分预测 5 年不良功能结局的受试者工作特征曲线下面积为 0.89（95%置信区间 0.88 至 0.91）。多变量 Cox 比例风险分析显示，ASTRAL 评分与 5 年不良功能结局独立相关（风险比 1.09，95%置信区间 1.08-1.10）。ASTRAL 评分预测 5 年死亡率的受试者工作特征曲线下面积为 0.81（95%置信区间 0.78-0.83）。多变量分析显示，ASTRAL 评分与 5 年死亡率独立相关（风险比 1.09，95%置信区间 1.08-1.10）。在 5 年随访期间，随着 ASTRAL 评分四分位数的增加，生存率显著降低（对数秩检验 <0.001）。
ASTRAL 评分能可靠地预测急性缺血性脑卒中患者 5 年的功能结局和死亡率。
