Stroke, Vol 25, 1935-1944, Copyright © 1994 by American Heart Association
CS Anderson, KD Jamrozik, RJ Broadhurst and EG Stewart-Wynne
BACKGROUND AND PURPOSE: Few studies have evaluated the factors influencing
or predicting long-term survival after stroke in an unselected series of
patients in whom the underlying cerebrovascular pathology is clearly
defined. Moreover, the relative importance of risk factors for stroke,
including sociodemographic and premorbid variables, has not been described
in detail. METHODS: The study cohort consisted of 492 patients with stroke
who were registered with a population-based study of acute cerebrovascular
disease undertaken in Perth, Western Australia, during an 18-month period
in 1989 and 1990. Objective evidence of the pathological basis of the
stroke was obtained in 86% of cases, and all deaths among patients during a
follow-up of 1 year were reviewed. RESULTS: One hundred twenty patients
(24%) died within 28 days of the onset of stroke. Among the different
subtypes of stroke, the 1-year case fatality (mean, 38%) varied from 6% and
16% for boundary zone infarction and lacunar infarction, respectively, to
42% and 46% for subarachnoid hemorrhage and primary intracerebral
hemorrhage, respectively. Using Cox proportional-hazards analysis, a
predictive model was developed on 321 patients with acute stroke (test
sample). The best model contained five baseline variables that were
independent predictors of death within 1 year: coma (relative risk [RR],
3.0; 95% confidence interval [CI], 1.1 to 8.4), urinary incontinence (RR,
3.9; 95% CI, 1.4 to 10.6), cardiac failure (RR, 6.5; 95% CI, 2.8 to 15.1),
severe paresis (RR, 4.9; 95% CI, 1.6 to 15.5), and atrial fibrillation (RR,
2.0; 95% CI, 1.1 to 3.5). The sensitivity, specificity, and negative
predictive value of this model for predicting death were 90%, 83%, and 95%,
respectively. When applied to a second randomly selected validation sample
of 171 events, sensitivity was 94%, specificity 62%, and negative
predictive value 92%, indicating stability of the model. CONCLUSIONS:
Although the case fatality, timing, and cause of death vary considerably
among the different pathological subtypes of stroke, simple clinical
measures that reflect the severity of the neurological deficit and
associated cardiac disease at onset independently predict death by 1 year
and may help to direct management.
ARTICLES
Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study
Department of Medicine, Flinders University of South Australia, Bedford Park.
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