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A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke
Adrian D Wood,Nicholas D Gollop,Joao H Bettencourt-Silva,Allan B Clark,Anthony K Metcalf,Kristian M Bowles,Marcus D Flather,John F Potter,Phyo Kyaw Myinta 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.4
Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The sub¬jects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquar¬tile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regres¬sion models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospi¬tal mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratifica¬tion using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateral¬ization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reli-ably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.
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