Prediction of Functional Outcome After Acute Ischemic Stroke: Comparison of the CT-DRAGON Score and a Reduced Features Set

被引：6

作者：

Lesenne, Anouk ^{[1
,2
]}

Grieten, Jef ^{[2
,3
]}

Ernon, Ludovic ^{[4
]}

Wibail, Alain ^{[4
]}

Stockx, Luc ^{[5
]}

Wouters, Patrick F. ^{[1
]}

Dreesen, Leentje ^{[5
]}

Vandermeulen, Elly ^{[2
]}

Van Boxstael, Sam ^{[2
]}

Vanelderen, Pascal ^{[2
,6
]}

Van Poucke, Sven ^{[2
]}

Vundelinckx, Joris ^{[2
]}

Van Cauter, Sofie ^{[5
]}

Mesotten, Dieter ^{[2
,6
]}

机构：

[1] Ghent Univ Hosp, Dept Anesthesiol & Perioperat Med, Ghent, Belgium

[2] Ziekenhuis Oost Limburg Genk, Dept Crit Care Serv, Genk, Belgium

[3] Vrije Univ Amsterdam, Dept Anesthesiol, Amsterdam, Netherlands

[4] Ziekenhuis Oost Limburg Genk, Dept Neurol, Genk, Belgium

[5] Ziekenhuis Oost Limburg Genk, Dept Med Imaging, Genk, Belgium

[6] UHasselt, Fac Med & Life Sci, Diepenbeek, Belgium

来源：

FRONTIERS IN NEUROLOGY | 2020年 / 11卷

关键词：

cerebrovascular disorders; stroke; prognosis; machine learning; thrombectomy; thrombolytic therapy; EXTERNAL VALIDATION; INTRAVENOUS THROMBOLYSIS; THROMBECTOMY; POPULATION;

D O I：

10.3389/fneur.2020.00718

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose:The CT-DRAGON score was developed to predict long-term functional outcome after acute stroke in the anterior circulation treated by thrombolysis. Its implementation in clinical practice may be hampered by its plethora of variables. The current study was designed to develop and evaluate an alternative score, as a reduced set of features, derived from the original CT-DRAGON score. Methods:This single-center retrospective study included 564 patients treated for stroke, in the anterior and the posterior circulation. At 90 days, favorable [modified Rankin Scale score (mRS) of 0-2] and miserable outcome (mRS of 5-6) were predicted by the CT-DRAGON in 427 patients. Bootstrap forests selected the most relevant parameters of the CT-DRAGON, in order to develop a reduced set of features. Discrimination, calibration and misclassification of both models were tested. Results:The area under the receiver operating characteristic curve (AUROC) for the CT-DRAGON was 0.78 (95% CI 0.74-0.81) for favorable and 0.78 (95% CI 0.72-0.83) for miserable outcome. Misclassification was 29% for favorable and 13.5% for miserable outcome, with a 100% specificity for the latter. National Institutes of Health Stroke Scale (NIHSS), pre-stroke mRS and age were identified as the strongest contributors to favorable and miserable outcome and named the reduced features set. While CT-DRAGON was only available in 323 patients (57%), the reduced features set could be calculated in 515 patients (91%) (p < 0.001). Misclassification was 25.8% for favorable and 14.4% for miserable outcome, with a 97% specificity for miserable outcome. The reduced features set had better discriminative power than CT-DRAGON for both outcomes (both p < 0.005), with an AUROC of 0.82 (95% CI 0.79-0.86) and 0.83 (95% CI 0.77-0.87) for favorable and miserable outcome, respectively. Conclusions:The CT-DRAGON score revealed acceptable discrimination in our cohort of both anterior and posterior circulation strokes, receiving all treatment modalities. The reduced features set could be measured in a larger cohort and with better discrimination. However, the reduced features set needs further validation in a prospective, multicentre study.

引用

页数：8

共 25 条

[1] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[2] MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours [J].

Ben Hassen, Wagih ;

Raynaud, Nicolas ;

Bricout, Nicolas ;

Boulouis, Gregoire ;

Legrand, Laurence ;

Ferrigno, Marc ;

Kazemi, Apolline ;

Bretzner, Martin ;

Soize, Sebastien ;

Farhat, Wassim ;

Seners, Pierre ;

Turc, Guillaume ;

Zuber, Mathieu ;

Oppenheim, Catherine ;

Cordonnier, Charlotte ;

Naggara, Olivier ;

Henon, Hilde .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2020, 12 (03) :246-251

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[5] External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke [J].

Cooray, Charith ;

Mazya, Michael ;

Bottai, Matteo ;

Dorado, Laura ;

Skoda, Ondrej ;

Toni, Danilo ;

Ford, Gary A. ;

Wahlgren, Nils ;

Ahmed, Niaz .

STROKE, 2016, 47 (06) :1493-U260

[6] Thinking About the Future: A Review of Prognostic Scales Used in Acute Stroke [J].

Drozdowska, Bogna A. ;

Singh, Sarjit ;

Quinn, Terence J. .

FRONTIERS IN NEUROLOGY, 2019, 10

[7] Clinical prediction models for mortality and functional outcome following ischemic stroke: A systematic review and meta-analysis [J].

Fahey, Marion ;

Crayton, Elise ;

Wolfe, Charles ;

Douiri, Abdel .

PLOS ONE, 2018, 13 (01)

[8] External Validation of the DRAGON Score in an Elderly Spanish Population: Prediction of Stroke Prognosis after IV Thrombolysis [J].

Giralt-Steinhauer, Eva ;

Rodriguez-Campello, Ana ;

Cuadrado-Godia, Elisa ;

Ois, Angel ;

Jimenez-Conde, Jordi ;

Soriano-Tarraga, Carolina ;

Roquer, Jaume .

CEREBROVASCULAR DISEASES, 2013, 36 (02) :110-114

[9] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[10]

Johnson CO, 2019, LANCET NEUROL, V18, P439, DOI [10.1016/S1474-4422(18)30454-X, 10.1016/S1474-4422(19)30034-1, 10.1016/S1474-4422(18)30443-5]

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