Papavasileiou Vasileios, Milionis Haralampos, Smith Craig J, Makaritsis Konstantinos, Bray Benjamin D, Michel Patrik, Manios Efstathios, Vemmos Konstantinos, Ntaios George
Comprehensive Stroke Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford Royal Foundation Trust, Manchester M6 8HD, UK.
Department of Medicine, Ioannina University Hospital, School of Medicine, University of Ioannina, Ioannina, Greece.
J Stroke Cerebrovasc Dis. 2015 Nov;24(11):2619-24. doi: 10.1016/j.jstrokecerebrovasdis.2015.07.017. Epub 2015 Sep 4.
The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) score was developed recently for predicting stroke-associated pneumonia (SAP), one of the most common complications after stroke. The aim of the present study was to externally validate the ISAN score.
Data included in the Athens Stroke Registry between June 1992 and December 2011 were used for this analysis. Inclusion criteria were the availability of all ISAN score variables (prestroke independence, sex, age, National Institutes of Health Stroke Scale score). Receiver operating characteristic curves and linear regression analyses were used to determine the discriminatory power of the score and to assess the correlation between actual and predicted pneumonia in the study population. Separate analyses were performed for patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH).
The analysis included 3204 patients (AIS: 2732, ICH: 472). The ISAN score demonstrated excellent discrimination in patients with AIS (area under the curve [AUC]: .83 [95% confidence interval {CI}: .81-.85]). In the ICH group, the score was less effective (AUC: .69 [95% CI: .63-.74]). Higher-risk groups of ISAN score were associated with an increased relative risk of SAP; risk increase was more prominent in the AIS population. Predicted pneumonia correlated very well with actual pneumonia (AIS group: R(2) = .885; β-coefficient = .941, P < .001; ICH group: R(2) = .880, β-coefficient = .938, P < .001).
In our external validation in the Athens Stroke Registry cohort, the ISAN score predicted SAP very accurately in AIS patients and demonstrated good discriminatory power in the ICH group. Further validation and assessment of clinical usefulness would strengthen the score's utility further.
卒中前独立性、性别、年龄、美国国立卫生研究院卒中量表（ISAN）评分是最近为预测卒中相关肺炎（SAP）而制定的，SAP是卒中后最常见的并发症之一。本研究的目的是对ISAN评分进行外部验证。
本分析使用了1992年6月至2011年12月雅典卒中登记处的数据。纳入标准是所有ISAN评分变量（卒中前独立性、性别、年龄、美国国立卫生研究院卒中量表评分）均可用。采用受试者工作特征曲线和线性回归分析来确定该评分的辨别力，并评估研究人群中实际肺炎与预测肺炎之间的相关性。对急性缺血性卒中（AIS）和脑出血（ICH）患者进行了单独分析。
分析纳入了3204例患者（AIS：2732例，ICH：472例）。ISAN评分在AIS患者中显示出优异的辨别力（曲线下面积[AUC]：0.83[95%置信区间{CI}：0.81 - 0.85]）。在ICH组中，该评分效果较差（AUC：0.69[95%CI：0.63 - 0.74]）。ISAN评分的高风险组与SAP的相对风险增加相关；在AIS人群中风险增加更为显著。预测肺炎与实际肺炎相关性非常好（AIS组：R(2)=0.885；β系数=0.941，P<0.001；ICH组：R(2)=0.880，β系数=0.938，P<0.001）。
在我们对雅典卒中登记队列的外部验证中，ISAN评分在AIS患者中非常准确地预测了SAP，在ICH组中显示出良好的辨别力。进一步的验证和临床实用性评估将进一步增强该评分的效用。
