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Multicentric validation of a reduced features case-mix set for predicting functional outcome after ischemic stroke in Belgium

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Abstract

Introduction

Ischemic stroke is the second cause of death and leading cause of severe disability worldwide. A reduced features set of CT-DRAGON (age, NIHSS on admission and pre-stroke mRS) predicts 90-day functional outcome after stroke in a single center. The current study was designed to validate this adapted CT-DRAGON score in three major Belgian hospitals, in the framework of future case-mix adjustment.

Methods

This retrospective study included stroke patients, treated by thrombolysis, thrombectomy, a combination of both or neither thrombolysis or thrombectomy (conservative treatment) in 2019. Patient characteristics and 90-day mRS were collected. Multivariable logistic regression analysis of 90-day mRS 0–2 vs. 3–6 and 0–5 vs. 6 with the reduced features set was performed. Discriminative performance was assessed by the area under the receiver operating characteristic curve (AUROC).

Results

Thirty-three percent of patients (413/1243) underwent treatment. Majority of strokes was treated conservatively (n = 830, 67%), 18% (n = 225) was treated by thrombolysis, 7% (n = 88) by thrombectomy and 8% (n = 100) by thrombolysis and thrombectomy. Age, NIHSS and pre-stroke mRS were independently associated with 90-day mRS 0–2 (all p ≤ 0.0001, AUROC 0.88).

When treatment modality was added in the model, age, NIHSS, pre-stroke mRS and treatment modality were independently associated with 90-day mRS 0–2 (p < 0.0001, p < 0.0001, p < 0.0001 and p = 0.0001) AUROC 0.89). Age, NIHSS, pre-stroke mRS and treatment modality were independently associated with 90-day survival (p = 0.0001, p < 0.0001, p < 0.0001 and p = 0.008, AUROC 0.86).

Discussion

The reduced features set (age, NIHSS and pre-mRS) was independently associated with long-term functional outcome in a Belgian multicentric cohort, making it useful for case-mix adjustments in Belgian stroke centers. Treatment modality was associated with long-term outcome.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUROC:

Area under the receiver operating characteristic curve

CCI:

Charlson comorbidity index

CI:

Confidence interval

CT:

Computed tomography

DCT:

Door-to-CT time

DGT:

Door-to-groin time

DNT:

Door-to-needle time

mRS:

Modified rankin scale

NIHSS:

National institutes of health stroke scale

ROC:

Receiver operating characteristic

References

  1. Herpich F, Rincon F (2020) Management of acute ischemic stroke. Crit Care Med 48(11):1654–1663

    Article  PubMed  PubMed Central  Google Scholar 

  2. Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D et al (2019) Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18(5):439–458

    Article  Google Scholar 

  3. Drozdowska BA, Singh S, Quinn TJ (2019) Thinking about the future: a review of prognostic scales used in acute stroke. Front Neurol 10:274

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lesenne A, Grieten J, Ernon L, Wibail A, Stockx L (2020) Prediction of functional outcome after acute ischemic stroke: comparison of the CT-DRAGON score and a reduced features set. Front Neurol 11:718

    Article  PubMed  PubMed Central  Google Scholar 

  5. Quinn TJ, Singh S, Lees KR, Bath PM, Myint PK (2017) Validating and comparing stroke prognosis scales. Neurology 89(10):997–1002

    Article  PubMed  Google Scholar 

  6. Kremers F, Venema E, Duvekot M, Yo L, Bokkers R, Lycklama À, Nijeholt G et al (2022) Outcome prediction models for endovascular treatment of ischemic stroke: systematic review and external validation. Stroke 53:825–836

    Article  PubMed  Google Scholar 

  7. LeCouffe N, Kappelhof M, Treurniet K, Rinkel L, Bruggeman A, Berkhemer O et al (2021) A randomized trial of intravenous alteplase before endovascular treatment for stroke. N Engl J Med 385(20):1833–1844

    Article  CAS  PubMed  Google Scholar 

  8. FOD Volksgezondheid. Ziekenhuismortaliteit na hoofddiagnose van ischemische beroerte [Internet]. 2020 [cited 2022 Feb 11]. Available from: https://www.health.belgium.be/sites/default/files/9a._fiche_mortaliteit_ischemische_beroerte_nt_gevalideerd_def_nl.pdf

  9. Holliday E, Lillicrap T, Kleinig T, Choi PMC, Maguire J, Bivard A et al (2020) Developing a multivariable prediction model for functional outcome after reperfusion therapy for acute ischaemic stroke: study protocol for the targeting optimal thrombolysis outcomes (TOTO) multicentre cohort study. BMJ Open 10(4):1–7

    Article  Google Scholar 

  10. Ordies S, Peeters G, Lesenne A, Wouters P, Ernon L, Bekelaar K et al (2022) Interaction between stroke severity and quality indicators of acute stroke care: a single-center retrospective analysis. Acta Neurol Belg 122(1):173–180

    Article  PubMed  Google Scholar 

  11. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378(1):11–21

    Article  PubMed  Google Scholar 

  12. Campbell B, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ et al (2020) Effect of Intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke: The EXTEND-IA TNK Part 2 randomized clinical trial. JAMA 323(13):1257–1265

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B et al (2018) MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med 379(7):611–622

    Article  PubMed  Google Scholar 

  14. Albers GW, Lansberg MG, Kemp S, Tsai JP, Lavori P, Christensen S et al (2017) A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). Int J Stroke 12(8):896–905

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kuhrij LS, Wouters MW, van den Berg-Vos R, de Leeuw FE, Nederkoorn PJ (2018) The dutch acute stroke audit: benchmarking acute stroke care in the Netherlands. Eur Stroke J 3(4):361–368

    Article  PubMed  PubMed Central  Google Scholar 

  16. Groenwold RHH (2020) Informative missingness in electronic health record systems: the curse of knowing. Diagn Progn Res 4:8

    Article  PubMed  PubMed Central  Google Scholar 

  17. Oemrawsingh A, van Leeuwen N, Venema E, Limburg M, de Leeuw FE, Wijffels MP et al (2019) Value-based healthcare in ischemic stroke care: Case-mix adjustment models for clinical and patient-reported outcomes. BMC Med Res Methodol 19(1):229

    Article  PubMed  PubMed Central  Google Scholar 

  18. Katzan IL, Spertus J, Bettger JP, Bravata DM, Reeves MJ, Smith EE et al (2014) Risk adjustment of ischemic stroke outcomes for comparing hospital performance a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45:918–944

    Article  PubMed  Google Scholar 

  19. Belgian Health Care Knowledge Center; Michiels D, Sun Y, Thijs V, Rasit OS, Hemelsoet D et al. KCE REPORT 181As Stroke units: Doeltreffendheid en kwaliteitsindicatoren [Internet]. 2012 [cited 2022 Feb 2]. Available from: https://kce.fgov.be/sites/default/files/atoms/files/181A_Stroke_units_synthese.pdf

  20. Amini M, van Leeuwen N, Eijkenaar F, Mulder MJHL, Schonewille W, Nijeeholt GLA et al (2020) Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough. BMC Health Serv Res 20(1):998

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The Monitoring of Stroke Activities and Outcome Consortium includes following collaborators who were directly involved in patient care of the study. Luc Stockx, Tom De Beule, Geert Maleux, Olivier François, Ludovic Ernon, Pascal Vanelderen.

Funding

This work was supported by Interreg/SafePAT: project number Euregio Maas-Rijn EMR90, Province of Limburg Belgium, Limburg Clinical Research Center (LCRC)-Anesthesiology/Neurology Programme.

Author information

Author notes

  1. Sofie Ordies and Anouk Lesenne contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Genk, Belgium

    Sofie Ordies MD, MSc, PhD, Anouk Lesenne MD, Dieter Mesotten MD, PhD & Pascal Vanelderen MD, PhD

  2. Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium

    Sofie Ordies MD, MSc, PhD

  3. Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium

    Anouk Lesenne MD

  4. Department of Neurology, Ziekenhuis Oost-Limburg Genk, Genk, Belgium

    Kim Bekelaar MD & Ludovic Ernon MD

  5. Department of Neurology, University Hospitals Leuven, Leuven, Belgium

    Jelle Demeestere MD & Robin Lemmens MD, PhD

  6. Department of Neurology, AZ Groeninge Kortrijk, Kortrijk, Belgium

    Peter Vanacker MD, PhD

  7. Neurovascular Center and Stroke Unit Antwerp, Antwerp University Hospital, Antwerp, Belgium

    Peter Vanacker MD, PhD

  8. Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Peter Vanacker MD, PhD

  9. Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium

    Dieter Mesotten MD, PhD & Pascal Vanelderen MD, PhD

  10. Department of Radiology, Ziekenhuis Oost-Limburg Genk, Genk, Belgium

    Luc Stockx MD & Tom De Beule MD

  11. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Geert Maleux MD, PhD

  12. Department of Radiology, AZ Groeninge Kortrijk, Kortrijk, Belgium

    Olivier François MD

Authors
  1. Sofie Ordies MD, MSc, PhD
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  2. Anouk Lesenne MD
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  3. Kim Bekelaar MD
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  4. Jelle Demeestere MD
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  5. Robin Lemmens MD, PhD
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  6. Peter Vanacker MD, PhD
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  7. Dieter Mesotten MD, PhD
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Consortia

The Monitoring of Stroke Activities and Outcome Consortium

  • Luc Stockx MD
  • , Tom De Beule MD
  • , Geert Maleux MD, PhD
  • , Olivier François MD
  • , Ludovic Ernon MD
  •  & Pascal Vanelderen MD, PhD

Contributions

SO, AL and DM participated in the study design, checked the database for accuracy, performed the statistical analyses and drafted the manuscript. JD, RL and PV participated in the study design and revised the manuscript for important intellectual content. KB and LE supervised patient recruitment, participated in the study design and revised the manuscript for important intellectual content. JD, RL, PV and DM participated in the study design, supervised patient recruitment and helped drafting the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dieter Mesotten MD, PhD.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

This study was approved by the local independent ethics committees of AZ Groeninge Kortrijk (AZGS2020022), UZ Leuven (B371201941435) and Ziekenhuis Oost-Limburg Genk (19/0059U). The need for informed consent by patients was waived by the local Ethics Committee because of the retrospective nature of the study and all the procedures being performed as part of the routine clinical stroke care.

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Not applicable.

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Ordies, S., Lesenne, A., Bekelaar, K. et al. Multicentric validation of a reduced features case-mix set for predicting functional outcome after ischemic stroke in Belgium. Acta Neurol Belg 123, 545–551 (2023). https://doi.org/10.1007/s13760-022-02142-5

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  • DOI: https://doi.org/10.1007/s13760-022-02142-5

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