ASTRAL Score Predicts 5-Year Dependence and Mortality in Acute Ischemic Stroke
- 1 June 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 44 (6), 1616-1620
- https://doi.org/10.1161/STROKEAHA.113.001047
Abstract
Background and Purpose—: The ASTRAL score was externally validated showing remarkable consistency on 3-month outcome prognosis in patients with acute ischemic stroke. The present study aimed to evaluate ASTRAL score’s prognostic accuracy to predict 5-year outcome. Methods—: All consecutive patients with acute ischemic stroke registered in the Athens Stroke Registry between January 1, 1998, and December 31, 2010, were included. Patients were excluded if admitted >24 hours after symptom onset or if any ASTRAL score component was missing. End points were 5-year unfavorable functional outcome, defined as modified Rankin Scale 3 to 6, and 5-year mortality. For each outcome, the area under the receiver operating characteristics curve was calculated; also, a multivariate Cox proportional hazards analysis was performed to investigate whether the ASTRAL score was an independent predictor of outcome. The Kaplan–Meier product limit method was used to estimate the probability of 5-year survival for each ASTRAL score quartile. Results—: The area under the receiver operating characteristics curve of the score to predict 5-year unfavorable functional outcome was 0.89, 95% confidence interval 0.88 to 0.91. In multivariate Cox proportional hazards analysis, the ASTRAL score was independently associated with 5-year unfavorable functional outcome (hazard ratio, 1.09; 95% confidence interval, 1.08–1.10). The area under the receiver operating characteristics curve for the ASTRAL score’s discriminatory power to predict 5-year mortality was 0.81 (95% confidence interval, 0.78–0.83). In multivariate analysis, the ASTRAL score was independently associated with 5-year mortality (hazard ratio, 1.09, 95% confidence interval, 1.08–1.10). During the 5-year follow-up, the probability of survival was significantly lower with increasing ASTRAL score quartiles (log-rank test <0.001). Conclusions—: The ASTRAL score reliably predicts 5-year functional outcome and mortality in patients with acute ischemic stroke.This publication has 22 references indexed in Scilit:
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