A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke

作者：Wood Adrian D; Gollop Nicholas D; Bettencourt Silva Joao H; Clark Allan B; Metcalf Anthony K; Bowles Kristian M; Flather Marcus D; Potter John F; Myint Phyo Kyaw^*

来源：Journal of Clinical Neurology, 2016, 12(4): 407-413.

DOI：10.3988/jcn.2016.12.4.407

• total anterior circulation stroke
• risk factors
• in-hospital mortality
• prognosis
• prognosis score
• advanced age

Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TAGS). We examined the characteristics and comorbidity data for TAGS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TAGS.
Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TAGS (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 TAGS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome.
Results Factors associated with in-hospital mortality of TAGS 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 TAGS 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 TAGS and derived a 6-point TAGS Score that can be used to predict the prognosis of particular patients.

• 出版日期2016-10