Using 30-day modified rankin scale score to predict 90-day score in patients with intracranial hemorrhage: Derivation and validation of prediction model.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Intracranial Hemorrhages*; Humans ; Male ; Female ; Aged ; Middle Aged ; Cerebral Hemorrhage/complications ; Severity of Illness Index ; Glasgow Coma Scale ; Prognosis ; Aged, 80 and over
    • Abstract:
      Whether 30-day modified Rankin Scale (mRS) scores can predict 90-day scores is unclear. This study derived and validated a model to predict ordinal 90-day mRS score in an intracerebral hemorrhage (ICH) population using 30-day mRS values and routinely available baseline variables. Adults enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage-2 (ATACH-2) trial between May 2011 and September 2015 with acute ICH, who were alive at 30 days and had mRS scores reported at both 30 and 90 days were included in this post-hoc analysis. A proportional odds regression model for predicting ordinal 90-day mRS scores was developed and internally validated using bootstrapping. Variables in the model included: mRS score at 30 days, age (years), hematoma volume (cm3), hematoma location (deep [basal ganglia, thalamus], lobar, or infratentorial), presence of intraventricular hemorrhage (IVH), baseline Glasgow Coma Scale (GCS) score, and National Institutes of Health Stroke Scale (NIHSS) score at randomization. We assessed model fit, calibration, discrimination, and agreement (ordinal, dichotomized functional independence), and EuroQol-5D ([EQ-5D] utility weighted) between predicted and observed 90-day mRS. A total of 898/1000 participants were included. Following bootstrap internal validation, our model (calibration slope = 0.967) had an optimism-corrected c-index of 0.884 (95% CI = 0.873-0.896) and R2 = 0.712 for 90-day mRS score. The weighted ĸ for agreement between observed and predicted ordinal 90-day mRS score was 0.811 (95% CI = 0.787-0.834). Agreement between observed and predicted functional independence (mRS score of 0-2) at 90 days was 74.3% (95% CI = 69.9-78.7%). The mean ± SD absolute difference between predicted and observed EQ-5D-weighted mRS score was negligible (0.005 ± 0.145). This tool allows practitioners and researchers to utilize clinically available information along with the mRS score 30 days after ICH to reliably predict the mRS score at 90 days.
      Competing Interests: WLB and GF have no conflicts of interest to report. MS reports receiving research grants from Bristol Myers Squibb, Bayer, and Javelin Medical; and consulting fees from Janssen, HLS Therapeutics, AstraZeneca, and Bayer. AC has received fees for serving on an adjudication committee from Boehringer Ingelheim and AbbVie; grant support and fees for serving on committees from AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, and Pfizer; consulting fees from Janssen, Portola Pharmaceuticals, and Ono Pharmaceuticals; and fees for serving on a steering committee and consulting fees from Bayer. MJC is a previous employee of AstraZeneca. MO and BC are employees of AstraZeneca. TEM has nothing to disclose. CIC has received research funding and/or consulting honoraria from Janssen Pharmaceuticals, Bayer AG, and AstraZeneca.
      (Copyright: © 2024 Baker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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    • Publication Date:
      Date Created: 20240521 Date Completed: 20240521 Latest Revision: 20240710
    • Publication Date:
      20240710
    • Accession Number:
      PMC11108121
    • Accession Number:
      10.1371/journal.pone.0303757
    • Accession Number:
      38771834