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Abstract
Objective To determine whether a new index for multiple chronic conditions (MCCs) predicts poststroke functional outcome (FO), we developed and internally validated the new MCC index in patients with ischemic stroke.
Methods A prospective cohort of patients with ischemic stroke (2008–2017) was interviewed at baseline and 90 days in the Brain Attack Surveillance in Corpus Christi Project. An average of 22 activities of daily living (ADL)/instrumental ADL (IADL) items measured the FO score (range 1–4) at 90 days. A FO score >3 (representing a lot of difficulty with ADL/IADLs) was considered unfavorable FO. A new index was developed using machine learning techniques to select and weight conditions and prestroke impairments.
Results Prestroke modified Rankin Scale (mRS) score, age, congestive heart failure (CHF), weight loss, diabetes, other neurologic disorders, and synergistic effects (dementia × age, CHF × renal failure, and prestroke mRS × prior stroke/TIA) were identified as important predictors in the MCC index. In the validation dataset, the index alone explained 31% of the variability in the FO score, was well-calibrated (p = 0.41), predicted unfavorable FO well (area under the receiver operating characteristic curve 0.81), and outperformed the modified Charlson Comorbidity Index in predicting the FO score and poststroke mRS.
Conclusions A new MCC index was developed and internally validated to improve the prediction of poststroke FO. Novel predictors and synergistic interactions were identified.
Classification of Evidence This study provides Class II evidence that in patients with ischemic stroke, an index for MCC predicts FO at 90 days.
Glossary
- ADL=
- activities of daily living;
- AUC=
- area under the receiver operating characteristic curve;
- BASIC=
- Brain Attack Surveillance in Corpus Christi;
- BMI=
- body mass index;
- FO=
- functional outcome;
- CHF=
- congestive heart failure;
- IADL=
- instrumental activities of daily living;
- ICD-9=
- International Classification of Diseases–9;
- ICD-10=
- International Classification of Diseases–10;
- IQCODE=
- Informant Questionnaire on Cognitive Decline in the Elderly;
- IQR=
- interquartile range;
- Lasso=
- least absolute shrinkage and selection operator;
- MA=
- Mexican American;
- MCC=
- multiple chronic conditions;
- mCCI=
- modified Charlson Comorbidity Index;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- ROC=
- receiver operating characteristic;
- VIF=
- variance inflation factor
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.
Coinvestigators are listed in the appendix 2 at the end of the article.
Class of Evidence: NPub.org/coe
- Received January 14, 2020.
- Accepted in final form August 20, 2020.
- © 2020 American Academy of Neurology
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