Comparing the Predictive Ability of Prognostic Models in Ischemic Stroke; Derivation, Validation, and Discrimination Beyond the ROC Curve

Objective We conducted this study to assess the role of CHA2DS2-VASc score in predicting ischemic stroke among systemic lupus erythematosus (SLE) patients without atrial fibrillation (AF). Methods We selected the SLE patients from the Registry of Catastrophic Illnesses Patient Database in Taiwan. We excluded the SLE patients with AF or atrial flutter. The patients were followed up until the occurrence of ischemic stroke, censored for death or withdrawal from the dataset, or the end of follow-up. Cox models were performed to obtain the hazard ratios (HRs) and the 95% confidence intervals (CIs) of ischemic stroke associated with the CHA2DS2-VASc score. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive ability of CHA2DS2-VASc score for ischemic stroke in SLE patients without AF. Results A total of 11,962 study participants were included in this study. The incidence of ischemic stroke increased from 4.00 per 1000 person-years (PYs) for patients with a CHA2DS2-VASc score of 0 to 87.4 per 1000 PYs for those with a CHA2DS2-VASc score of ≧6. Moreover, patients with a CHA2DS2-VASc score of ≧2 were 3.98-fold (95% CI 3.15–5.04) more likely to develop ischemic stroke than those with a CHA2DS2-VASc score of <2 (14.0 vs. 2.99 per 1000 PYs). ROC curve analysis of the CHA2DS2-VASc score demonstrated a moderate discrimination power for ischemic stroke development with a c-statistic of 0.65(95% CI 0.62–0.69). Conclusions We found that a CHA2DS2-VASc score greater than or equal to 2 in SLE patients without AF is associated with a significantly higher rate of ischemic stroke.

Download Full-text

Anthropometric indices obesity and cardiometabolic risk: is there a link?

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-2746 ◽

2021 ◽

Vol 20 (4) ◽

pp. 2746

Author(s):

A. V. Svarovskaya ◽

A. A. Garganeeva

Keyword(s):

Cardiometabolic Risk ◽

Predictive Ability ◽

Dietary Lipids ◽

The Body ◽

Prognostic Models ◽

Metabolic Phenotype ◽

Visceral Adiposity Index ◽

Obesity Indices ◽

Relationship Of ◽

The Relationship

Adipose tissue is currently regarded as a key organ for excess dietary lipids, which determine whether the body will maintain normal homeostasis or whether inflammation and insulin resistance will develop. In recent years, there is more information about novel prognostic models — the visceral adiposity index and the lipid accumulation product. The aim of this review was to analyze the results of studies examining the relationship between various indices of obesity and cardiometabolic risk. We analyzed 105 literature sources, 53 of which were ruled out, becausethe processes of interest were not described in detail or included anassessment of the relationship of various obesity indices with metabolic parameters. The results obtained indicate the advisability of using novel obesity indices, which have a good predictive ability and are simple and convenient to use. It is necessary to use additional methods of anthropometric and clinical examination in order to assess the metabolic phenotype of obesity, which will make it possible to stratify patients by the level of cardiometabolic risk.

Download Full-text

Abstract TMP64: Single Stroke Symptoms Cannot Predict Large Vessel Occlusion in Patients With Acute Ischemic Stroke With a High Reliability

Stroke ◽

10.1161/str.48.suppl_1.tmp64 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jon Schrock ◽

Ashley Markowski

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Roc Curve ◽

Clinical Symptoms ◽

High Reliability ◽

Hospital Setting ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Roc Curve Analysis ◽

Vessel Occlusion

Background: Identification of acute ischemic stroke patients (AIS) with large vessel occlusion (LVO) in the pre-hospital setting is paramount now that endovascular treatment has become the standard of care. Correctly identifying this AIS population will allow transport to appropriate stroke centers with endovascular stroke capabilities. Objectives: We choose to evaluate single symptoms which, if present, might signify an ischemic stroke with a LVO. We tested if the following stroke symptoms including hemiplegia, severe dysarthria, neglect, eye deviation were associated with a LVO. Our hypothesis is that the use of these selected single or multiple NIHSS symptoms will not result in a ROC of > 0.9 rendering it effective in LVO diagnosis. Methods: A retrospective cohort review was conducted of 551 AIS patients who presented to the emergency department over a 77 month period. Subject demographics clinical symptoms, and other pertinent information were collected from the medical record. The following symptoms at ED presentation were evaluated with univariate and multivariate regression and ROC curve analysis; hemiplegia (of arm and leg), dysarthria (severe), neglect, and eye deviation. Results: Out of the 551 patients, 220 (40%) had a moderate stroke (NIHSS >9) while 143 (26%) had a severe stroke (NIHSS>14) and 49% were male. The median NIHSS was 7 (IQR 4-15) and 228 (41%) had LVO on CTA. The odds ratio and area under the ROC curve for hemiplegia, severe dysarthria, neglect, and eye deviation were respectively OR 3.2 (2.2- 4.5), 3.2 (2.2- 4.6), 5.5 (3.4- 8.9), 7.7 (4.6- 13.1) and area under the ROC 0.63, 0.64, 0.63, and 0.64 respectively. The results of multivariate analysis were slightly better with an ROC of 0.72. Conclusions: Singular stroke symptoms do not have the diagnostic power to predict which patient with AIS will have a LVO. While they have positive odds ratios, the ROC analysis suggests that individually or in combination, they are not accurate enough to determine the presence of LVO.

Download Full-text

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

10.21203/rs.2.46/v1 ◽

2018 ◽

Author(s):

Matthew Scalise ◽

Jordan Gainey ◽

Benjamin Bailes ◽

Leanne Brecthtel ◽

Zachary Conn ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Prognostic Models ◽

Broca's Aphasia ◽

Stroke Patients ◽

Motor Speech ◽

Stroke Registry ◽

Broca’S Aphasia ◽

Thrombolysis Therapy

Abstract Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

Download Full-text

Comments on ‘Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond’ by M. J. Pencina, R. B. D'Agostino Sr, R. B. D'Agostino Jr, R. S. Vasan,Statistics in Medicine (DOI: 10.1002/sim.2929)

Statistics in Medicine ◽

10.1002/sim.2976 ◽

2007 ◽

Vol 27 (2) ◽

pp. 188-190 ◽

Cited By ~ 7

Author(s):

Philip Greenland

Keyword(s):

Roc Curve ◽

Predictive Ability

Download Full-text

P5742Prognostic model of the development of the first atherothrombotic stroke

European Heart Journal ◽

10.1093/eurheartj/ehz746.0682 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Shishkova ◽

L Stakhovskaya ◽

T V Adasheva ◽

A Remennic ◽

V Valyaeva

Keyword(s):

Ischemic Stroke ◽

Roc Curve ◽

Probability Model ◽

Vascular Inflammation ◽

Molecular Genetic ◽

Binary Logistic Regression ◽

Forecast Model ◽

Training Sample ◽

Nucleotide Polymorphisms ◽

Apo B

Abstract Aim The study of the relationship between various parameters: clinical-anthropometric, biochemical, metabolic, vascular-inflammatory, molecular-genetic and the development of the first ischemic stroke, and the development of a prognostic model for determining the probability of its occurrence. Material and methods 196 patients who underwent the first ischemic stroke and 119 people who did not suffer a stroke, corresponding to age, place of residence and nationality to a group of patients, were examined. The main anthropometric, clinical, biochemical and metabolic parameters were assessed; markers of vascular inflammation and endothelial dysfunction. Genotyping of single nucleotide polymorphisms of genes: IL8, ADIPOQ, ADIROR, APOB, APOC-IV, BDNF, GRM3 using ready-made TaqMan probes was carried out. Results Based on the results of the correlation analysis, the following parameters were statistically significant with the first ischemic stroke: weight, BMI, WC, homocysteine, insulin, adiponectin, cystatin C, ApoA1, Apo B, OHL, XC-HDL, LDL, TG, CRB-sh, glucose, uric acid, IL-1b, IL-4, IL-6, IL-8, TNF-a, VEGF-A. The binary logistic regression method was used to construct the forecast model. The final independent model includes the following independent variables: weight, diabetes, adiponectin, Apo A1, IL-1b, IL-4, ADIPOQ (rs17366743), GRM3 (rs2228595), R2 value of Nagelkerk was 0.839. The percentage of agreement between the model and the “training sample” was 90.7%. The percentage of consent of the model with the “independent sample” was 87.1%, the overall percentage of the model's agreement for all patients was 89.8%. In accordance with the received data, the ROC-curve (Receiver Operating Characteristic) was constructed, the area under the ROC-curve was 0.92. Conclusion Based on the data obtained in this study, a probability model for the development of the first ischemic stroke was obtained. Of all the parameters studied in the study, the largest contribution to the probability of development of the first ischemic stroke, according to the model obtained, is made by the parameters: diabetes, adiponectin, Apo A1, IL-4. Acknowledgement/Funding None

Download Full-text

Development and Validation of a Nomogram Prognostic Model for Patients With Advanced Non-Small-Cell Lung Cancer

Cancer Informatics ◽

10.1177/1176935119837547 ◽

2019 ◽

Vol 18 ◽

pp. 117693511983754 ◽

Cited By ~ 2

Author(s):

Tao Wang ◽

Rong Lu ◽

Sunny Lai ◽

Joan H Schiller ◽

Fang Liz Zhou ◽

...

Keyword(s):

Roc Curve ◽

Prognostic Model ◽

Advanced Nsclc ◽

Small Cell ◽

Prognostic Models ◽

P Value ◽

Concordance Index ◽

Small Cell Lung ◽

Patient Cohort ◽

Nsclc Patients

Importance: Nomogram prognostic models can facilitate cancer patient treatment plans and patient enrollment in clinical trials. Objective: The primary objective is to provide an updated and accurate prognostic model for predicting the survival of advanced non-small-cell lung cancer (NSCLC) patients, and the secondary objective is to validate a published nomogram prognostic model for NSCLC using an independent patient cohort. Design: 1817 patients with advanced NSCLC from the control arms of 4 Phase III randomized clinical trials were included in this study. Data from 524 NSCLC patients from one of these trials were used to validate a previously published nomogram and then used to develop an updated nomogram. Patients from the other 3 trials were used as independent validation cohorts of the new nomogram. The prognostic performances were comprehensively evaluated using hazard ratios, integrated area under the curve (AUC), concordance index, and calibration plots. Setting: General community. Main outcome: A nomogram model was developed to predict overall survival in NSCLC patients. Results: We demonstrated the prognostic power of the previously published model in an independent cohort. The updated prognostic model contains the following variables: sex, histology, performance status, liver metastasis, hemoglobin level, white blood cell counts, peritoneal metastasis, skin metastasis, and lymphocyte percentage. This model was validated using various evaluation criteria on the 3 independent cohorts with heterogeneous NSCLC populations. In the SUN1087 patient cohort, the continuous risk score output by the nomogram achieved an integrated area under the receiver operating characteristics (ROC) curve of 0.83, a log-rank P-value of 3.87e−11, and a concordance index of 0.717. In the SAVEONCO patient cohort, the integrated area under the ROC curve was 0.755, the log-rank P-value was 4.94e−6 and the concordance index was 0.678. In the VITAL patient cohort, the integrated area under the ROC curve was 0.723, the log-rank P-value was 1.36e−11, and the concordance index was 0.654. We implemented the proposed nomogram and several previously published prognostic models on an online Web server for easy user access. Conclusions: This nomogram model based on basic clinical features and routine lab testing predicts individual survival probabilities for advanced NSCLC and exhibits cross-study robustness.

Download Full-text

The Risk of Developing Ischemic Stroke in Patients After Exacerbation of Ischemic Heart Disease

Kardiologiia ◽

10.18087/cardio.2020.8.n1197 ◽

2020 ◽

Vol 60 (8) ◽

pp. 46-53

Author(s):

V. A. Brazhnik ◽

L. O. Minushkina ◽

N. R. Khasanov ◽

E. D. Kosmacheva ◽

M. A. Chichkova ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Stroke ◽

Ischemic Heart Disease ◽

Roc Curve ◽

Prognostic Model ◽

External Validation ◽

Diagnostic Value ◽

Ischemic Heart ◽

Blood Pressure Goal ◽

Coronary Syndrome

Aim To develop a model for evaluating the risk of stroke in patients after exacerbation of ischemic heart disease who were admitted to the hospitals included into a vascular program.Materials and methods This study included 1803 patients with acute coronary syndrome (ACS) from four institutions of Moscow, Kazan, Astrakhan, and Krasnodar where the vascular program was established. Mean age of patients was 64.9±12.78 years, 62,1 % of them were men. The patients were followed up for one year after the discharge from the hospital. External validation of the developed prognostic model was performed on a cohort of patients with ACS included into the RECORD-3 study.Results During the follow-up period, 42 cases of ischemic stroke were observed. The risk of ischemic stroke was associated with the presence of atrial fibrillation (odd ratio (OR) 2.640; р=0.037), diabetes mellitus (OR 2.718; р=0.041), and chronic heart failure (OR 7.049; р=0.011). Protective factors were high-density lipoprotein cholesterol >1 mmol/l (OR 0.629; р=0.041), percutaneous coronary intervention during an index hospitalization (OR 0.412; р=0.042), anticoagulant treatment (OR 0.670; р=0.049), and achieving the blood pressure goal (OR 0.604; р=0.023). The prognostic model developed on the basis of regression analysis showed a good predictive value (area under the ROC curve, 0.780), sensitivity of 80 %, and specificity of 64.6 %. The diagnostic value of other scales for risk assessment was somewhat lower. The area under the ROC curve was 0.692±0.0245 for the GRACE scale and 0.708±0.0334 for CHA2DS2‑VASc. In the external validation of the scale based on data of the RECORD-3 study, the diagnostic value was lower although satisfactory as well (area under the ROC curve, 0.651); sensitivity was 78.9 %, and specificity was 52.3 %.Conclusion The study resulted in development of a simple clinical scale, which will probably allow identifying groups at risk of stroke more precisely than with standard scales.

Download Full-text

Isolation and identification of serum exosomes and correlation of its contents with acute ischemic stroke

10.21203/rs.3.rs-108426/v1 ◽

2020 ◽

Author(s):

Pei Yu ◽

Wencheng Chen

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Roc Curve ◽

Target Genes ◽

Quantitative Polymerase Chain Reaction ◽

Disease Diagnosis ◽

Control Group ◽

Isolation And Identification ◽

Diagnostic Potential ◽

Serum Exosomes

Abstract Background Erythrocyte deformability is one of the pathophysiological changes of high-risk factors such as smoking, hypertension and atherosclerosis in stroke. It mainly affects blood viscosity and fluidity in the occurrence, development and outcome of the disease. Exosomes are a new type of biological activity test target, and it mainly contents miRNA, but its effect on stroke is still not clear. Objective To detect the serum exosome-derived miR-150-5p expression in patients with acute ischemic stroke and explore its diagnostic potential for acute ischemic stroke. Methods A total of 84 samples were collected with matched age and gender, collecting relevant laboratory indicators and general clinical data of the research subjects. The kit was used to extract serum exosomes, real-time fluorescent quantitative polymerase chain reaction was used to determine the expression of serum exosomal miR-150-5p, evaluate its value as a diagnostic marker through the ROC curve. Through Randa, Target Scan and other online databases, bioinformatics methods predict the target genes of miR-150, the results are drawn Venny to take intersection analysis, literature screening and ischemic stroke related target genes. Results The exosomes showed elliptical or round membranous vesicles with a diameter between 30–200 nm and fusion phenomenon and detected the exosomal marker proteins CD63 and HSP70; Compared with the control group, the relative expression of exosomal miR-150-5p in patients with acute ischemic stroke was increased (T = 8, P < 0.001). The expression of serum exosomal miR-150-5p in the disease group at different time points after stroke, the difference was not statistically significant(Chi-square = 2.925, P = 0.232); the area under the ROC curve was 0.883. bioinformatics prediction analysis of miR-150 target genes, which may be involved in the development of stroke disease through EGR2 and PLP2, as well as erythrocyte membrane protein-related genes SLC4A1 and SPTB also belong to the miR-150 prediction targets. Conclusion The expression of exosome-derived miR-150-5p is relatively high in patients with acute stroke, and it has a certain potential for early disease diagnosis.

Download Full-text

Heart Score for Predicting in Hospital Major Cardiovascular Event in Patient with Non ST Segment Elevation Acute Coronary Syndrome

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v6i2.623 ◽

2020 ◽

Vol 6 (2) ◽

pp. 85-90

Author(s):

Kamal Kharrazi Ilyas ◽

Sutomo Kasiman ◽

Harris Hasan ◽

Zulfikri Mukhtar ◽

Refli Hasan ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

General Hospital ◽

Cardiovascular Event ◽

Roc Curve ◽

Predictive Value ◽

Predictive Ability ◽

St Segment Elevation ◽

Heart Score ◽

Coronary Syndrome ◽

St Segment

Background: Acute Coronary Syndrome (ACS) is one of the main problems in the field of cardiovascular diseases because of high hospitalization rate, high mortality and high medical cost. Rapid and accurate risk stratification is needed to calculate the risk of complication and right now exist two most used score which is GRACE and TIMI. Heart score has 5 simple variables that can be calculated easily and this score considered to have better predictive ability compared to other score. The aim of this study is to examine HEART score as a predictor for in hospital Major Cardiovascular Event (MACE) in patient diagnosed as Non ST Segment Elevation Acute Coronary Syndrome (NSTEACS) that hospitalized at Haji Adam Malik (HAM) General Hospital Medan. Methods: This is a prospective cohort study that includes 52 NSTEACS patient that hospitalized at HAM General Hospital since November 2018 until January 2019. Patient that diagnosed as NSTEACS were calculated for GRACE, TIMI, and HEART score then observed during hospitalization. Outcome of this study is MACE during hospitalization. Statistical analysis was performed to test HEART score as MACE predictor and then comparison was done with GRACE and TIMI Results: By using ROC curve analysis, the cut-off value of HEART score was 5 (AUC 0.947, 95% CI 0.883-0.997, p<0.01). Study subject that experienced MACE with HEART score ≥5 was 21 patients (87.5%) compared to 2 patients (7.1%). HEART score ≥5 can predict MACE with sensitivity 87.5%, specificity 92.9%, negative predictive value (NPV) 89.7% and positive predictive value (PPV) 91.3%. ROC curve comparison was done between HEART with GRACE and TIMI then it was found that HEART score has better predictive ability compared to TIMI and GRACE (AUC 0.947 vs 0.829 vs 0.807, p < 0.01). Conclusion: HEART score can be used as MACE predictor which is relatively simpler but have better predictive ability compared to GRACE and TIMI.

Download Full-text