Development of a new non invasive prognostic stroke scale (NIPSS) including triage elements for sleep apnea and peripheral artery disease

Afiliação

(1)    Post-Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Brazil (UFBA), Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA.

(2)    Stroke Unit, Hospital Geral Roberto Santos, Brazil.

(3)    Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA, Brazil.

(4)    Universidade Faculdade de Salvador (UNIFACS), Bahia, Brazil.

(5)    Post-Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Brazil (UFBA), Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA.

Resumo

Background: Although sleep apnea and peripheral artery disease are prognostic factors for stroke, their added benefit in the acute stage to further prognosticate strokes has not been evaluated. Objectives: We tested the accuracy in the acute stroke stage of a novel score called the Non-Invasive Prognostic Stroke Scale (NIPSS). Patients and methods: Prospective cohort with imaging-confirmed ischemic stroke. Clinical data, sleep apnea risk score (STOPBANG) and blood pressure measures were collected at baseline. Primary outcome was the 90-day modified Rankin Scale (mRS), with poor outcome defined as mRS 3-6. Area under the ROC curve (AUC) was calculated for NIPSS and compared to six other stroke prognostic scores in our cohort: SPAN-100 index, S-SMART, SOAR, ASTRAL, THRIVE, and Dutch Stroke scores. Results: We enrolled 386 participants. After 90 days, there were 56% with poor outcome, more frequently older, female predominant and with higher admission National Institute of Health Stroke Scale (NIHSS). Four variables remained significantly associated with primary endpoint in the multivariable model: age (OR 1.87), NIHSS (OR 7.08), STOPBANG category (OR 1.61), and ankle-braquial index (OR 2.11). NIPSS AUC was 0.86 (0.82-0.89); 0.83 (0.79-0.87) with bootstrapping. When compared to the other scores, NIPSS, ASTRAL, S-SMART and DUTCH scores had good abilities in predicting poor outcome, with AUC of 0.86, 0.86, 0.83 and 0.82, respectively. THRIVE, SOAR and SPAN-100 scores were fairly predictive. Discussion and conclusions: Non-invasive and easily acquired emergency room data can predict clinical outcome after stroke. NIPSS performed equal to or better than other prognostic stroke scales.