A Risk Score Based on Get With the Guidelines–Stroke Program Data Works in Patients With Acute Ischemic Stroke in China

Abstract

Background and Purpose—: There are few validated models for prediction of in-hospital mortality after acute ischemic stroke. In 2010, Smith et al developed and internally validated models for predicting in-hospital mortality based on Get With the Guidelines–Stroke program data. We demonstrate the applicability of this Get With the Guidelines risk model in Chinese patients. Methods—: The prognostic model was used to predict survival in 7015 patients with acute ischemic stroke from China National Stroke Registry data set. Model discrimination was quantified by calculating C statistic. To clarify the role of National Institutes of Health Stroke Scale (NIHSS), we also calculated the C statistics for NIHSS alone and for the model without NIHSS. Results—: The C statistic was 0.867 (95% CI, 0.839–0.895) through the Get With the Guidelines risk model, suggesting good discrimination in the China National Stroke Registry. The model without NIHSS produced significantly lower C statistic (0.735; 95% CI, 0.701–0.770; P <0.001), indicating the important role of NIHSS in the prediction of survival. Furthermore, a model with NIHSS alone also provided significant discrimination (C statistic, 0.847; 95% CI, 0.816–0.879). A plot of observed versus predicted mortality showed excellent model calibration in the external validation sample from the China National Stroke Registry. Conclusions—: The Get With the Guidelines risk model could correctly predict in-hospital mortality in Chinese patients with ischemic stroke. In addition, the NIHSS provides substantial incremental information on a patient’s short-term mortality risk and is the strongest predictor of mortality.