发病后第 4 天改良 Rankin 量表残疾状况是预测第 90 天长期结局的有用指标。

Modified Rankin Scale disability status at day 4 poststroke is an informative predictor of long-term day 90 outcome.

机构信息

Department of Neurology, David Geffen School of Medicine at UCLA; Department of Neurology, Kaiser Permanente Los Angeles Medical Center.

Department of Neurology, David Geffen School of Medicine at UCLA.

出版信息

J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107902. doi: 10.1016/j.jstrokecerebrovasdis.2024.107902. Epub 2024 Jul 29.

DOI:10.1016/j.jstrokecerebrovasdis.2024.107902

PMID:39084338

Abstract

BACKGROUND

Long-term disability after stroke is standardly assessed 3 months post-onset, using the modified Rankin Scale (mRS). The value of an early, day 4 mRS assessment for projecting the 3-month disability outcome has not been formally investigated.

METHODS

In this cohort of patients with acute cerebral ischemia and intracranial hemorrhage, we analyzed day 4 and day 90 mRS assessments in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) Phase 3 trial. The performance of day 4 mRS, alone and as part of multivariate models, in predicting day 90 mRS was assessed using correlation coefficients, percent agreement, and the kappa statistics.

RESULTS

Among the 1573 acute cerebrovascular disease (ACVD) patients, 1206 (76.7%) had acute cerebral ischemia (ACI), while 367 (23.3%) had intracranial hemorrhage. Among all 1573 ACVD patients, day 4 mRS and day 90 mRS correlated strongly, Spearman's rho=0.79, in unadjusted analysis with weighted kappa of 0.59. For dichotomized outcomes, simple carry-forward of the day 4 mRS performed fairly well in agreeing with day 90 mRS: mRS 0-1 (kappa=0.67), 85.4%; mRS 0-2 (k=0.59), 79.5%; fatal outcome, 88% (k=0.33). Correlations of 4d and 90d mRS were stronger for ACI than ICH patients, 0.76 vs 0.71.

CONCLUSIONS

In this acute cerebrovascular disease patient cohort, assessment of global disability performed on day 4 is highly informative regarding long-term, 3-month mRS disability outcome, alone, and even more strongly in combination with baseline prognostic variables. The day 4 mRS is a useful measure for imputing the final patient disability outcome in clinical trials and quality improvement programs.

摘要

背景

脑卒中后长期残疾的标准评估时间为发病后 3 个月，采用改良 Rankin 量表（mRS）。尚未正式研究第 4 天 mRS 评估对预测 3 个月残疾结局的早期价值。

方法

在 NIH 急性卒中治疗-镁剂（FAST-MAG）3 期试验的急性脑缺血和颅内出血患者队列中，我们分析了第 4 天和第 90 天 mRS 的评估。采用相关系数、百分比一致性和 Kappa 统计分析第 4 天 mRS 单独以及作为多变量模型的一部分预测第 90 天 mRS 的性能。

结果

在 1573 例急性脑血管病（ACVD）患者中，1206 例（76.7%）为急性脑缺血（ACI），367 例（23.3%）为颅内出血。在所有 1573 例 ACVD 患者中，第 4 天 mRS 和第 90 天 mRS 相关性很强，未经调整分析 Spearman's rho=0.79，加权 Kappa 值为 0.59。对于二分结局，简单的第 4 天 mRS 向前推断与第 90 天 mRS 非常吻合：mRS 0-1（Kappa=0.67），85.4%；mRS 0-2（K=0.59），79.5%；致命结局，88%（K=0.33）。与 ICH 患者相比，ACI 患者的第 4 天和第 90 天 mRS 的相关性更强，分别为 0.76 和 0.71。