Xiaqing Jiang1, Lu Wang1, Lewis B Morgenstern1, Christine T Cigolle1, Edward S Claflin1, Lynda D Lisabeth2. 1. From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI. 2. From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI. llisabet@umich.edu.
Abstract
OBJECTIVE: To determine whether a new index for multiple chronic conditions (MCCs) predicts poststroke functional outcome (FO), we developed and internally validated the new MCC index in patients with ischemic stroke. METHODS: A prospective cohort of patients with ischemic stroke (2008-2017) was interviewed at baseline and 90 days in the Brain Attack Surveillance in Corpus Christi Project. An average of 22 activities of daily living (ADL)/instrumental ADL (IADL) items measured the FO score (range 1-4) at 90 days. A FO score >3 (representing a lot of difficulty with ADL/IADLs) was considered unfavorable FO. A new index was developed using machine learning techniques to select and weight conditions and prestroke impairments. RESULTS: Prestroke modified Rankin Scale (mRS) score, age, congestive heart failure (CHF), weight loss, diabetes, other neurologic disorders, and synergistic effects (dementia × age, CHF × renal failure, and prestroke mRS × prior stroke/TIA) were identified as important predictors in the MCC index. In the validation dataset, the index alone explained 31% of the variability in the FO score, was well-calibrated (p = 0.41), predicted unfavorable FO well (area under the receiver operating characteristic curve 0.81), and outperformed the modified Charlson Comorbidity Index in predicting the FO score and poststroke mRS. CONCLUSIONS: A new MCC index was developed and internally validated to improve the prediction of poststroke FO. Novel predictors and synergistic interactions were identified. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with ischemic stroke, an index for MCC predicts FO at 90 days.
OBJECTIVE: To determine whether a new index for multiple chronic conditions (MCCs) predicts poststroke functional outcome (FO), we developed and internally validated the new MCC index in patients with ischemic stroke. METHODS: A prospective cohort of patients with ischemic stroke (2008-2017) was interviewed at baseline and 90 days in the Brain Attack Surveillance in Corpus Christi Project. An average of 22 activities of daily living (ADL)/instrumental ADL (IADL) items measured the FO score (range 1-4) at 90 days. A FO score >3 (representing a lot of difficulty with ADL/IADLs) was considered unfavorable FO. A new index was developed using machine learning techniques to select and weight conditions and prestroke impairments. RESULTS: Prestroke modified Rankin Scale (mRS) score, age, congestive heart failure (CHF), weight loss, diabetes, other neurologic disorders, and synergistic effects (dementia × age, CHF × renal failure, and prestroke mRS × prior stroke/TIA) were identified as important predictors in the MCC index. In the validation dataset, the index alone explained 31% of the variability in the FO score, was well-calibrated (p = 0.41), predicted unfavorable FO well (area under the receiver operating characteristic curve 0.81), and outperformed the modified Charlson Comorbidity Index in predicting the FO score and poststroke mRS. CONCLUSIONS: A new MCC index was developed and internally validated to improve the prediction of poststroke FO. Novel predictors and synergistic interactions were identified. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with ischemic stroke, an index for MCC predicts FO at 90 days.
Authors: Melinda A Smith; Jan M H Risser; Lemuel A Moyé; Nelda Garcia; Olubumi Akiwumi; Ken Uchino; Lewis B Morgenstern Journal: Ethn Dis Date: 2004 Impact factor: 1.847
Authors: Lynda D Lisabeth; Brisa N Sánchez; Jonggyu Baek; Lesli E Skolarus; Melinda A Smith; Nelda Garcia; Devin L Brown; Lewis B Morgenstern Journal: Stroke Date: 2014-03-13 Impact factor: 7.914
Authors: Xiaqing Jiang; Lewis B Morgenstern; Christine T Cigolle; Lu Wang; Edward S Claflin; Lynda D Lisabeth Journal: Stroke Date: 2021-09-14 Impact factor: 7.914