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A parsimonious score with a free web tool for predicting disability after an ischemic stroke: the Parsifal Score

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Abstract

Background

Most of the models to predict prognosis after an ischemic stroke include complex mathematical equations or too many variables, making them difficult to use in the daily clinic. We want to predict disability 3 months after an ischemic stroke in an independent patient not receiving recanalization treatment within the first 24 h, using a minimum set of variables and an easy tool to facilitate its implementation. As a secondary aim, we calculated the capacity of the score to predict an excellent/devastating outcome and mortality.

Methods

Eight hundred and forty-four patients were evaluated. A multivariable ordinal logistic regression was used to obtain the score. The Modified Rankin Scale (mRS) was used to estimate disability at the third month. The results were replicated in another independent cohort (378 patients). The “polr” function of R was used to perform the regression, stratifying the sample into seven groups with different cutoffs (from mRS 0 to 6).

Results

The Parsifal score was generated with: age, previous mRS, initial NIHSS, glycemia on admission, and dyslipidemia. This score predicts disability with an accuracy of 80–76% (discovery–replication cohorts). It has an AUC of 0.86 in the discovery and replication cohort. The specificity was 90–80% (discovery–replication cohorts); while, the sensitivity was 64–74% (discovery–replication cohorts). The prediction of an excellent or devastating outcome, as well as mortality, obtained good discrimination with AUC > 0.80.

Conclusions

The Parsifal Score is a model that predicts disability at the third month, with only five variables, with good discrimination and calibration, and being replicated in an independent cohort.

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Acknowledgements

This work was supported by a grant from Instituto de Salud Carlos III (PI 11/0176), Generación Project, Maestro Project, INVICTUS + network, Epigenesis Project (Marató de TV3) and FEDER funds. E. Muiño is supported by a Río Hortega Contract (CM18/00198) from Instituto de Salud Carlos III. J. Cárcel-Márquez is supported by AGAUR Contract (agència de gestió d'ajuts universitaris i de recerca; FI_DGR 2019, grant number 2019_FI_B 00853). A. Bustamante is supported by a Juan Rodés Research Contract (JR16/00008) from Instituto de Salud Carlos III.

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Authors and Affiliations

  1. Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain

    E. Muiño, C. Gallego-Fabrega, N. Cullell, N. Torres-Aguila & J. Cárcel-Márquez

  2. Fundació Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    E. Muiño, C. Gallego-Fabrega, C. Carrera, N. Cullell, N. Torres-Aguila, J. Cárcel-Márquez & I. Fernández-Cadenas

  3. Departamento de Medicina de la UAB, Universitat Autónoma de Barcelona, Barcelona, Spain

    E. Muiño

  4. Neurovascular Research Laboratory, Vall d’Hebron Institute of Research, Hospital Vall d’Hebron-UAB, Barcelona, Spain

    A. Bustamante, C. Carrera & J. Montaner

  5. Neurology Service, IMIM-Hospital del Mar, Barcelona, Spain

    A. Rodriguez-Campello, A. Ois, E. Cuadrado-Godia, E. Giralt-Steinhauer, J. Jiménez-Conde & J. Roquer

  6. Neurology Service, Hospital Vall D’Hebron, Barcelona, Spain

    M. Rubiera & C. A. Molina

  7. Biomedicine Institute of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain

    J. Montaner

  8. Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain

    J. Montaner

Authors
  1. E. Muiño
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  2. A. Bustamante
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  3. A. Rodriguez-Campello
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  4. C. Gallego-Fabrega
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  5. A. Ois
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  6. C. Carrera
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  8. N. Torres-Aguila
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  9. J. Cárcel-Márquez
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  10. M. Rubiera
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  11. C. A. Molina
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  12. E. Cuadrado-Godia
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  13. E. Giralt-Steinhauer
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  14. J. Jiménez-Conde
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  15. J. Montaner
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  16. I. Fernández-Cadenas
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  17. J. Roquer
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Corresponding author

Correspondence to I. Fernández-Cadenas.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standard statement

This study was approved by the local ethics committee and an informed consent document about the registry was signed by every patient or their relatives (code 2005/2088/I and 2008/3083/I for Discovery cohort, PR(AG)157/2011 for replication cohort).

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Muiño, E., Bustamante, A., Rodriguez-Campello, A. et al. A parsimonious score with a free web tool for predicting disability after an ischemic stroke: the Parsifal Score. J Neurol 267, 2871–2880 (2020). https://doi.org/10.1007/s00415-020-09914-0

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  • DOI: https://doi.org/10.1007/s00415-020-09914-0

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