This Article Full Text Full Text (PDF) All Versions of this Article: 40/2/530    most recent STROKEAHA.108.521906v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kissela, B. Articles by Tsevat, J. Search for Related Content PubMed PubMed Citation Articles by Kissela, B. Articles by Tsevat, J. Related Collections Acute Cerebral Infarction Behavioral Changes and Stroke

(Stroke. 2009;40:530.)
© 2009 American Heart Association, Inc.

Original Contributions

Clinical Prediction of Functional Outcome After Ischemic Stroke

The Surprising Importance of Periventricular White Matter Disease and Race

Brett Kissela, MD; Christopher J. Lindsell, PhD; Dawn Kleindorfer, MD; Kathleen Alwell, BSN; Charles J. Moomaw, PhD; Daniel Woo, MD, MS; Matthew L. Flaherty, MD; Ellen Air, MD, PhD; Joseph Broderick, MD Joel Tsevat, MD, MPH

From the Department of Neurology (B.K., D.K., K.A., C.J.M., D.W., M.L.F., J.B.), the Department of Emergency Medicine (C.J.L.), the Institute for the Study of Health Research (J.T.), and the Department of Neurosurgery (E.A.), University of Cincinnati, Ohio.

Correspondence to Brett Kissela, MD, University of Cincinnati College of Medicine, Department of Neurology, 260 Stetson Street, Suite 2300, Cincinnati, OH 45267-0525. E-mail Brett.kissela{at}uc.edu

Background and Purpose— We sought to build models that address questions of interest to patients and families by predicting short- and long-term mortality and functional outcome after ischemic stroke, while allowing for risk restratification as comorbid events accumulate.

Methods— A cohort of 451 ischemic stroke subjects in 1999 were interviewed during hospitalization, at 3 months, and at approximately 4 years. Medical records from the acute hospitalization were abstracted. All hospitalizations for 3 months poststroke were reviewed to ascertain medical and psychiatric comorbidities, which were categorized for analysis. Multivariable models were derived to predict mortality and functional outcome (modified Rankin Scale) at 3 months and 4 years. Comorbidities were included as modifiers of the 3-month models, and included in 4-year predictions.

Results— Poststroke medical and psychiatric comorbidities significantly increased short-term poststroke mortality and morbidity. Severe periventricular white matter disease (PVWMD) was significantly associated with poor functional outcome at 3 months, independent of other factors, such as diabetes and age; inclusion of this imaging variable eliminated other traditional risk factors often found in stroke outcomes models. Outcome at 3 months was a significant predictor of long-term mortality and functional outcome. Black race was a predictor of 4-year mortality.

Conclusions— We propose that predictive models for stroke outcome, as well as analysis of clinical trials, should include adjustment for comorbid conditions. The effects of PVWMD on short-term functional outcomes and black race on long-term mortality are findings that require confirmation.

Key Words: ischemic stroke • outcomes • white matter disease • race • models • predicted models

This article has been cited by other articles:

				G. Jickling, A. Salam, A. Mohammad, M. S. Hussain, J. Scozzafava, A. M. Nasser, T. Jeerakathil, A. Shuaib, and R. Camicioli Circulating Endothelial Progenitor Cells and Age-Related White Matter Changes Stroke, October 1, 2009; 40(10): 3191 - 3196. [Abstract] [Full Text] [PDF]

				P. Khatri, T. Abruzzo, S. D. Yeatts, C. Nichols, J. P. Broderick, T. A. Tomsick, and For the IMS I and II Investigators Good clinical outcome after ischemic stroke with successful revascularization is time-dependent Neurology, September 29, 2009; 73(13): 1066 - 1072. [Abstract] [Full Text] [PDF]