Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.).
Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.).
Stroke. 2022 Mar;53(3):825-836. doi: 10.1161/STROKEAHA.120.033445. Epub 2021 Nov 4.
Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice.
We systematically searched within Medline, Embase, Cochrane, Web of Science, to include prediction models. Models identified from the search were validated in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, which includes all patients treated with endovascular treatment within 6.5 hours after stroke onset in the Netherlands between March 2014 and November 2017. Predictive performance was evaluated according to discrimination (area under the curve) and calibration (slope and intercept of the calibration curve). Good functional outcome was defined as a score of 0-2 or 0-3 on the modified Rankin Scale depending on the model.
After screening 3468 publications, 19 models were included in this validation. Variables included in the models mainly addressed clinical and imaging characteristics at baseline. In the validation cohort of 3156 patients, discriminative performance ranged from 0.61 (SPAN-100 [Stroke Prognostication Using Age and NIH Stroke Scale]) to 0.80 (MR PREDICTS). Best-calibrated models were THRIVE (The Totaled Health Risks in Vascular Events; intercept -0.06 [95% CI, -0.14 to 0.02]; slope 0.84 [95% CI, 0.75-0.95]), THRIVE-c (intercept 0.08 [95% CI, -0.02 to 0.17]; slope 0.71 [95% CI, 0.65-0.77]), Stroke Checkerboard score (intercept -0.05 [95% CI, -0.13 to 0.03]; slope 0.97 [95% CI, 0.88-1.08]), and MR PREDICTS (intercept 0.43 [95% CI, 0.33-0.52]; slope 0.93 [95% CI, 0.85-1.01]).
The THRIVE-c score and MR PREDICTS both showed a good combination of discrimination and calibration and were, therefore, superior in predicting functional outcome for patients with ischemic stroke after endovascular treatment within 6.5 hours. Since models used different predictors and several models had relatively good predictive performance, the decision on which model to use in practice may also depend on simplicity of the model, data availability, and the comparability of the population and setting.
为了改善患者管理，已经开发出了用于预测接受血管内治疗的急性缺血性脑卒中患者结局的预测模型。本研究的目的是提供血管内治疗后功能结局的术前模型概述，并使用来自日常临床实践的数据对这些模型进行验证。
我们在 Medline、Embase、Cochrane、Web of Science 中进行了系统性检索，纳入了预测模型。从检索中确定的模型在 MR CLEAN（荷兰多中心急性缺血性脑卒中血管内治疗随机临床试验）登记处进行了验证，该登记处包括 2014 年 3 月至 2017 年 11 月期间荷兰在发病后 6.5 小时内接受血管内治疗的所有患者。根据区分度（曲线下面积）和校准（校准曲线的斜率和截距）评估预测性能。根据模型的不同，将良好的功能结局定义为改良 Rankin 量表评分为 0-2 或 0-3。
在筛选了 3468 篇文献后，纳入了 19 个模型进行验证。模型中纳入的变量主要涉及基线时的临床和影像学特征。在 3156 例患者的验证队列中，区分性能范围为 0.61（SPAN-100[使用年龄和 NIH 卒中量表预测卒中]）至 0.80（MR PREDICTS）。最佳校准模型为 THRIVE（血管事件总风险；截距-0.06[95%CI，-0.14 至 0.02]；斜率 0.84[95%CI，0.75-0.95]）、THRIVE-c（截距 0.08[95%CI，-0.02 至 0.17]；斜率 0.71[95%CI，0.65-0.77]）、Stroke Checkerboard 评分（截距-0.05[95%CI，-0.13 至 0.03]；斜率 0.97[95%CI，0.88-1.08]）和 MR PREDICTS（截距 0.43[95%CI，0.33-0.52]；斜率 0.93[95%CI，0.85-1.01]）。
THRIVE-c 评分和 MR PREDICTS 均表现出良好的区分度和校准度，因此在预测发病后 6.5 小时内接受血管内治疗的缺血性脑卒中患者的功能结局方面表现更优。由于模型使用了不同的预测因子，并且有几个模型具有相对较好的预测性能，因此在实践中使用哪个模型的决策可能还取决于模型的简单性、数据可用性以及人群和环境的可比性。
