Aryandhito Widhi Nugroho1, Hisatomi Arima2, Naoyuki Takashima3, Takako Fujii4, Satoshi Shitara4, Naomi Miyamatsu5, Yoshihisa Sugimoto6, Satoru Nagata7, Masaru Komori8, Yoshikuni Kita9, Katsuyuki Miura10, Kazuhiko Nozaki11. 1. Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan; Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan. 2. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan; Department of Public Health, Shiga University of Medical Science, Otsu, Japan. 3. Department of Public Health, Shiga University of Medical Science, Otsu, Japan. 4. Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan. 5. Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan. 6. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science, Otsu, Japan. 7. Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science, Otsu, Japan. 8. Department of Fundamental Biosciences, Shiga University of Medical Science, Otsu, Japan. 9. Department of Public Health, Shiga University of Medical Science, Otsu, Japan; Department of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan. 10. Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Public Health, Shiga University of Medical Science, Otsu, Japan. 11. Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan. Electronic address: noz@belle.shiga-med.ac.jp.
Abstract
BACKGROUND AND PURPOSE: Most available scoring system to predict outcome after acute ischemic stroke (AIS) were established in Western countries. We aimed to develop a simple prediction score of 1-month severe disability/death after onset in AIS patients ineligible for recanalization therapy based on readily and widely obtainable on-admission clinical, laboratory and radiological examinations in Asian developing countries. METHODS: Using the Shiga Stroke Registry, a large population-based registry in Japan, multivariable logistic regression analysis was conducted in 1617 AIS patients ineligible for recanalization therapy to yield ß-coefficients of significant predictors of 1-month modified Rankin Scale score of 5-6, which were then multiplied by a specific constant and rounded to nearest integer to develop 0-10 points system. Model discrimination and calibration were evaluated in the original and bootstrapped population. RESULTS: Japan Coma Scale score (J), age (A), random glucose (G), untimely onset-to-arrival time (U), atrial fibrillation (A), and preadmission dependency status according to the modified Rankin Scale score (R), were recognized as independent predictors of outcome. Each of their β-coefficients was multiplied by 1.3 creating the JAGUAR score. Its area under the curve (95% confidence interval) was .901 (.880- .922) and .901 (.900- .901) in the original and bootstrapped population, respectively. It was found to have good calibration in both study population (P = .27). CONCLUSIONS: The JAGUAR score can be an important prediction tool of severe disability/death in AIS patients ineligible for recanalization therapy that can be applied on admission with no complicated calculation and multimodal neuroimaging necessary, thus suitable for Asian developing countries.
BACKGROUND AND PURPOSE: Most available scoring system to predict outcome after acute ischemic stroke (AIS) were established in Western countries. We aimed to develop a simple prediction score of 1-month severe disability/death after onset in AISpatients ineligible for recanalization therapy based on readily and widely obtainable on-admission clinical, laboratory and radiological examinations in Asian developing countries. METHODS: Using the Shiga Stroke Registry, a large population-based registry in Japan, multivariable logistic regression analysis was conducted in 1617 AISpatients ineligible for recanalization therapy to yield ß-coefficients of significant predictors of 1-month modified Rankin Scale score of 5-6, which were then multiplied by a specific constant and rounded to nearest integer to develop 0-10 points system. Model discrimination and calibration were evaluated in the original and bootstrapped population. RESULTS: Japan Coma Scale score (J), age (A), random glucose (G), untimely onset-to-arrival time (U), atrial fibrillation (A), and preadmission dependency status according to the modified Rankin Scale score (R), were recognized as independent predictors of outcome. Each of their β-coefficients was multiplied by 1.3 creating the JAGUAR score. Its area under the curve (95% confidence interval) was .901 (.880- .922) and .901 (.900- .901) in the original and bootstrapped population, respectively. It was found to have good calibration in both study population (P = .27). CONCLUSIONS: The JAGUAR score can be an important prediction tool of severe disability/death in AISpatients ineligible for recanalization therapy that can be applied on admission with no complicated calculation and multimodal neuroimaging necessary, thus suitable for Asian developing countries.