A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke.
10.3988/jcn.2016.12.4.407
- Author:
Adrian D WOOD
1
;
Nicholas D GOLLOP
;
Joao H BETTENCOURT-SILVA
;
Allan B CLARK
;
Anthony K METCALF
;
Kristian M BOWLES
;
Marcus D FLATHER
;
John F POTTER
;
Phyo Kyaw MYINT
Author Information
1. Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. phyo.myint@abdn.ac.uk
- Publication Type:Original Article
- Keywords:
total anterior circulation stroke;
risk factors;
in-hospital mortality;
prognosis;
prognosis score;
advanced age
- MeSH:
Comorbidity;
Heart Failure;
Hospital Mortality*;
Humans;
Male;
Mortality;
Odds Ratio;
Prognosis;
Risk Factors;
Stroke*
- From:Journal of Clinical Neurology
2016;12(4):407-413
- CountryRepublic of Korea
- Language:English
-
Abstract:
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 subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression 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-hospital 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 stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=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)] reliably 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.
