22. European Stroke Conference 70 Stroke prognosis A patient-specific predicting tool for functional recovery after stroke J.J. Grace1, A. Douiri2, A.G. Rudd3, C. McKevitt4, C.A. Wolfe5 King’s College London, London, UNITED KINGDOM1, King’s College London, London, UNITED KINGDOM2, King’s College London, London, UNITED KINGDOM3, King’s College London, London, UNITED KINGDOM4, King’s College London, London, UNITED KINGDOM5 Objectives: Existing prognostic models of stroke recovery are rare. This study aimed to develop and validate a patient-specific model for predicting functional recovery up to 1 year post-stroke. Methods: Data were from 495 patients recruited from the population-based South London Stroke Register. Functional assessments were performed using the Barthel Index (BI) at 1, 2, 3, 4, 6, 8, 12, 26 and 52 weeks after stroke. Multilevel growth models were used to predict BI trajectories, recov-ery curves, allowing for day-to-day and between-patient variation. Cross-validation procedures were used for selecting strong predictors of BI model parameters. The predictive performance of the re-covery curves was validated using 10-fold internal cross-validation. The model was also validated for classification accuracy of poor BI (<8) outcomes at 3 and 12 months using 2 external samples totaling 1830 stroke patients. Results: Mean age was 71 years, 51% were females and 24% died within the first year. Age, gen-der, NIH Stroke Scale, Glasgow Coma Scale and stroke subtype were identified as independent predictors of BI. Accuracy of the recovery curves model were satisfactory, with a root mean square deviation less than 2.3 BI points at 3 and 12 months. The model was highly effective at classifying patients as likely to have poor outcome or not at 3 and 12 months, which is a clinically useful dis-tinction. 316 © 2013 S. Karger AG, Basel Scientific Programme Conclusions: The model predicts functional recovery over time after stroke and could potentially aid clinicians in early identification of and intervention with patients at risk of poorer than expected functional outcome. 71 Stroke prognosis Hemostatic factors as predictors of recurrent vascular events up to 12 years after ischemic stroke: the Sahlgrenska Academy Study on Ischemic Stroke Outcome C. Jern1, A. Pedersén2, P. Redfors3, L. Lundberg4, E. Hanson5, C. Blomstrand6, A. Rosengren7, K. Jood8 Institute of Neuroscience and Physiology, the Sahlgrenska Academy at Gothenburg University, Goteborg, SWEDEN1, Institute of Neuroscience and Physiology, Goteborg, SWEDEN2, Institute of Neuroscience and Physiology, Goteborg, SWEDEN3, Institute of Neuroscience and Physiology, Goteborg, SWEDEN4, Institute of Neuroscience and Physiology, Goteborg, SWEDEN5, Institute of Neuroscience and Physiology, Goteborg, SWEDEN6, Institute of Medicine, Goteborg, SWEDEN7, Institute of Neuroscience and Physiology, Goteborg, SWEDEN8 Background: The hemostatic factors tissue plasminogen activator (tPA), von Willebrand factor (vWF) and fibrinogen are known from prospective studies to predict vascular events. Here, we in-vestigate the relations between tPA antigen, vWF and fibrinogen levels and the risk of vascular events in a population of young and middle-aged ischemic stroke sufferers. Methods: As part of the Sahlgrenska Academy Study on Ischemic Stroke Outcome, 600 consecutive patients with ischemic stroke (IS) before 70 years of age were prospectively followed. Blood was drawn in the acute and the convalescent phase (3 months) after index stroke. Vascular deaths, re-current stroke, and coronary events were registered through national registers and medical records. Hazard ratios (HR) for associations between plasma levels and recurrent vascular events were calcu-lated using Cox Regression models. Results: Patients were followed up to 12 years with a mean follow-up time of 8.5 (SD 1.6) years. No patient was lost to follow-up. We registered 75 vascular deaths, 119 recurrent strokes, and 53 coro-nary events. In univariate analyses both acute and convalescent levels of all three hemostatic factors showed significant associations with vascular death. The same was true when analyzing all events combined (n=184), except for the acute levels of vWF. No significant associations were observed with recurrent stroke. In multivariate analyses, adjusting for vascular risk factors and hsCRP, the association for convalescent plasma levels of tPA antigen and vascular death was retained, HR per 1 SD increase 1.40 (95% CI 1.05-1.88, p=0.02). Conclusion: In young and middle-aged ischemic stroke sufferers, the convalescent plasma level of tPA is an independent predictor of long-term risk of vascular death. Levels of tPA, vWF and fibrin-ogen are associated with an increased risk of the combined outcome of fatal and non-fatal vascular events. However, these associations are not independent of vascular risk factors.
Karger_ESC London_2013
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