验证 DRAGON 评分在前循环和后循环 12 个卒中中心的适用性。
Validation of the DRAGON score in 12 stroke centers in anterior and posterior circulation.
机构信息
From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia (A.M., C.B., S.M.D.); Department of Neurology, Box Hill Hospital, Box Hill, Australia (S.C., C.B.); Department of Neurology, University Lille Nord de France, Lille, France (R.B., D.L.); Department of Neurology, Hospital Clínic Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain (V.O., A.C.); Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland (B.W.); Department of Neurology, University of Bern, Bern, Switzerland (S.J., H.P.M.); and Department of Neurology, University of Perugia, Perugia, Italy (V.C.).
出版信息
Stroke. 2013 Oct;44(10):2718-21. doi: 10.1161/STROKEAHA.113.002033. Epub 2013 Aug 8.
BACKGROUND AND PURPOSE
The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation.
METHODS
Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0-2) and miserable (modified Rankin scale score, 5-6) outcomes.
RESULTS
Area under the receiver operating characteristic curve was 0.84 (0.82-0.85) for miserable outcome and 0.82 (0.80-0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance (P=0.55); areas under the receiver operating characteristic curve were 0.84 (0.83-0.86) and 0.82 (0.78-0.87), respectively. No sex-related difference in performance was observed (P=0.25).
CONCLUSIONS
The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).
背景与目的
DRAGON 评分可预测接受静脉溶栓治疗的缺血性脑卒中患者超急性期的功能结局。我们旨在该评分在前循环和后循环的大型多中心队列中进行验证。
方法
合并了 12 家卒中中心连续接受静脉溶栓治疗的缺血性脑卒中患者的前瞻性采集数据（n=5471）。我们排除了缺乏计算评分所需数据的患者和缺少 3 个月改良 Rankin 量表评分的患者。最终队列纳入了 4519 例合格患者。我们在整个队列中用受试者工作特征曲线下面积评估了 DRAGON 评分对不良（改良 Rankin 量表评分 5-6）和良好（改良 Rankin 量表评分 0-2）结局的预测性能。
结果
不良结局的受试者工作特征曲线下面积为 0.84（0.82-0.85），良好结局为 0.82（0.80-0.83）。0-1、2、3 和 8-10 分的患者中，良好结局的比例分别为 96%、93%、78%和 0%。不良结局的比例分别为 0%、2%、4%、89%和 97%。在前循环和后循环中分别进行测试时，其性能无差异（P=0.55）；受试者工作特征曲线下面积分别为 0.84（0.83-0.86）和 0.82（0.78-0.87）。未观察到性能与性别相关的差异（P=0.25）。
结论
DRAGON 评分在前循环和后循环卒中的大型合并队列中均表现出良好的性能。DRAGON 评分可快速评估患者预后，支持卒中急性期的临床决策（例如，考虑侵入性附加策略时）。
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