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Abstract
Objectives To derive and externally validate a copeptin-based parsimonious score to predict unfavorable outcome 3 months after an acute ischemic stroke (AIS).
Methods The derivation cohort consisted of patients with AIS enrolled prospectively at the University Hospital Basel, Switzerland. The validation cohort was prospectively enrolled after the derivation cohort at the University Hospital of Bern and University Hospital Basel, Switzerland, as well as Frankfurt a.M., Germany. The score components were copeptin levels, age, NIH Stroke Scale, and recanalization therapy (CoRisk score). Copeptin levels were measured in plasma drawn within 24 hours of AIS and before any recanalization therapy. The primary outcome of disability and death at 3 months was defined as modified Rankin Scale score of 3 to 6.
Results Overall, 1,102 patients were included in the analysis; the derivation cohort contributed 319 patients, and the validation cohort contributed 783. An unfavorable outcome was observed among 436 patients (40%). For the 3-month prediction of disability and death, the CoRisk score was well calibrated in the validation cohort, for which the area under the receiver operating characteristic curve was 0.819 (95% confidence interval [CI] 0.787–0.849). The calibrated CoRisk score correctly classified 75% of patients (95% CI 72–78). The net reclassification index between the calibrated CoRisk scores with and without copeptin was 46% (95% CI 32–60).
Conclusions The biomarker-based CoRisk score for the prediction of disability and death was externally validated, was well calibrated, and performed better than the same score without copeptin.
ClinicalTrials.gov identifier NCT00390962 (derivation cohort) and NCT00878813 (validation cohort).
Glossary
- ASTRAL=
- Acute Stroke Registry and Analysis of Lausanne;
- AUC=
- area under the receiver operating characteristic curve;
- CI=
- confidence interval;
- CoRisk=
- Copeptin for Risk Stratification in Acute Stroke Patients;
- COSMOS=
- Copeptin in Osmoregulation and Stress Assessment;
- JURaSSIC=
- Clinician Judgment Versus Risk Score to Predict Stroke Outcomes;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- NRI=
- net reclassification index;
- PLAN=
- preadmission comorbidities, level of consciousness, age, and neurologic deficit;
- SOAR=
- stroke subtype, Oxfordshire Community Stroke Project, age, and prestroke modified Rankin Scale;
- THRIVE=
- Totaled Health Risks in Vascular Events;
- VISTA=
- Virtual International Stroke Trials Archive
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received July 20, 2018.
- Accepted in final form November 14, 2018.
- © 2019 American Academy of Neurology
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