一种基于新型生物标志物的急性缺血性脑卒中预后评分：CoRisk 评分。
A novel biomarker-based prognostic score in acute ischemic stroke: The CoRisk score.
机构信息
From the Department of Neurology & Stroke Center (G.M.D.M., J.F., H.G., S.T.E., P.A.L.), Department of Internal Medicine (M.C.-C.), and Department of Clinical Research (M.C.-C.), Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, University of Basel, Switzerland; Institute of Medical Biometry and Statistics (T.D., I.R.K.), University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (F.F.), University Hospital Würzburg; Department of Neurology (C.F.), Goethe University, Frankfurt a.M., Germany; Department of Neurology (O.F.), Cantonal Hospital Aarau; Department of Neurology (R.K., U.F., M.A.), Inselspital, University Hospital Bern; Department of Neurology (A.L., M.K.), University Hospital Zurich; Department of Laboratory Medicine (D.B.), Kantonsspital, Lucerne; and Neurorehabilitation Unit (S.T.E.), University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Switzerland.
出版信息
Neurology. 2019 Mar 26;92(13):e1517-e1525. doi: 10.1212/WNL.0000000000007177. Epub 2019 Mar 1.
OBJECTIVES
To derive and externally validate a copeptin-based parsimonious score to predict unfavorable outcome 3 months after an acute ischemic stroke (AIS).
METHODS
The derivation cohort consisted of patients with AIS enrolled prospectively at the University Hospital Basel, Switzerland. The validation cohort was prospectively enrolled after the derivation cohort at the University Hospital of Bern and University Hospital Basel, Switzerland, as well as Frankfurt a.M., Germany. The score components were copeptin levels, age, NIH Stroke Scale, and recanalization therapy (CoRisk score). Copeptin levels were measured in plasma drawn within 24 hours of AIS and before any recanalization therapy. The primary outcome of disability and death at 3 months was defined as modified Rankin Scale score of 3 to 6.
RESULTS
Overall, 1,102 patients were included in the analysis; the derivation cohort contributed 319 patients, and the validation cohort contributed 783. An unfavorable outcome was observed among 436 patients (40%). For the 3-month prediction of disability and death, the CoRisk score was well calibrated in the validation cohort, for which the area under the receiver operating characteristic curve was 0.819 (95% confidence interval [CI] 0.787-0.849). The calibrated CoRisk score correctly classified 75% of patients (95% CI 72-78). The net reclassification index between the calibrated CoRisk scores with and without copeptin was 46% (95% CI 32-60).
CONCLUSIONS
The biomarker-based CoRisk score for the prediction of disability and death was externally validated, was well calibrated, and performed better than the same score without copeptin.
CLINICALTRIALSGOV IDENTIFIER
NCT00390962 (derivation cohort) and NCT00878813 (validation cohort).
目的
推导并外部验证一种基于 copeptin 的简化评分，以预测急性缺血性脑卒中（AIS）后 3 个月的不良结局。
方法
推导队列由瑞士巴塞尔大学医院前瞻性纳入的 AIS 患者组成。验证队列在推导队列之后，由瑞士伯尔尼大学医院和巴塞尔大学医院以及德国法兰克福大学医院前瞻性纳入。评分成分包括 copeptin 水平、年龄、NIH 卒中量表和再通治疗（CoRisk 评分）。在 AIS 后 24 小时内抽取血浆并在任何再通治疗之前测量 copeptin 水平。残疾和 3 个月死亡的主要结局定义为改良 Rankin 量表评分 3-6。
结果
共有 1102 名患者纳入分析；推导队列贡献了 319 名患者，验证队列贡献了 783 名患者。436 名患者（40%）出现不良结局。对于 3 个月的残疾和死亡预测，CoRisk 评分在验证队列中具有良好的校准度，其受试者工作特征曲线下面积为 0.819（95%置信区间 [CI] 0.787-0.849）。校准后的 CoRisk 评分正确分类了 75%的患者（95%CI 72-78）。有 copeptin 与无 copeptin 的校准 CoRisk 评分之间的净重新分类指数为 46%（95%CI 32-60）。
结论
基于生物标志物的 CoRisk 评分预测残疾和死亡的外部验证、良好校准度，且表现优于不包含 copeptin 的相同评分。
临床试验注册号
NCT00390962（推导队列）和 NCT00878813（验证队列）。
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