Prediction of Outcome in Embolic Strokes of Undetermined Source

Simona Lattanzi; Alessandra Pulcini; Tommaso Corradetti; Claudia Rinaldi; Maria Luisa Zedde; Giuseppe Ciliberti; Mauro Silvestrini

doi:10.1016/j.jstrokecerebrovasdis.2019.104486

Prediction of Outcome in Embolic Strokes of Undetermined Source

J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104486. doi: 10.1016/j.jstrokecerebrovasdis.2019.104486. Epub 2019 Nov 6.

Authors

Simona Lattanzi¹, Alessandra Pulcini², Tommaso Corradetti², Claudia Rinaldi², Maria Luisa Zedde³, Giuseppe Ciliberti⁴, Mauro Silvestrini²

Affiliations

¹ Neurological Clinic, Marche Polytechnic University, Italy. Electronic address: alfierelattanzisimona@gmail.com.
² Neurological Clinic, Marche Polytechnic University, Italy.
³ Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy.
⁴ Cardiology Clinic, Marche Polytechnic University, Italy.

PMID: 31706753
DOI: 10.1016/j.jstrokecerebrovasdis.2019.104486

Abstract

Background and aim: Predicting outcome after stroke is a major goal and research field. The Embolic Stroke of Undetermined Source (ESUS) is a recently introduced clinical construct, and the prediction of outcome in this population has to be further explored. The aim of the study was to evaluate the prognostic validity and accuracy of the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) score in patients with ESUS.

Methods: Consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria were identified and the ASTRAL scores estimated. The study endpoint was the 3-month unfavorable outcome (modified Rankin Scale>2). Predictive performance was investigated through logistic regression analysis and discrimination and calibration tests.

Results: Among 202 patients with ESUS, 67 (33.2%) had unfavourable 3-month outcome. The ASTRAL score was an independent predictor of poor outcome [_adjOR = 1.44, 95% confidence interval (CI) 1.30-1.60, P < .001], showed good discriminatory power (area under the receiver operating characteristic curve .913, 95% CI .871-.956) and was well calibrated (Hosmer-Lemeshow test P = .496).

Conclusions: The ASTRAL score was an independent predictor of 3-month functional outcome and showed high predictive accuracy in patients with ESUS.

Keywords: Stroke; cerebral ischemia; cerebrovascular disease; embolic stroke of undetermined source.

Publication types

Validation Study

MeSH terms

Activities of Daily Living
Aged
Aged, 80 and over
Brain Ischemia / diagnosis*
Brain Ischemia / physiopathology
Brain Ischemia / therapy
Decision Support Techniques*
Disability Evaluation
Female
Humans
Intracranial Embolism / diagnosis*
Intracranial Embolism / physiopathology
Intracranial Embolism / therapy
Male
Middle Aged
Predictive Value of Tests
Recovery of Function
Reproducibility of Results
Retrospective Studies
Stroke / diagnosis*
Stroke / physiopathology
Stroke / therapy
Time Factors
Treatment Outcome