Prognostic models of mortality following first‐ever acute ischemic stroke: A population‐based retrospective cohort study

Mohammed, Mustapha, Zainal, Hadzliana, Ong, Siew Chin, Tangiisuran, Balamurugan, Aziz, Fatimatuzzahra Abdul, Sidek, Norsima N., Sha'aban, Abubakar ORCID: https://orcid.org/0000-0002-5491-9851, Ibrahim, Umar Idris, Muhammad, Surajuddeen, Looi, Irene and Aziz, Zariah A. 2025. Prognostic models of mortality following first‐ever acute ischemic stroke: A population‐based retrospective cohort study. Health Science Reports 8 (2) , e70445. 10.1002/hsr2.70445

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Abstract

Background and Aims: There is a lack of population‐based studies focusing on guideline‐based prognostic models for stroke. This study aimed to develop and validate a prognostic model that predicts mortality following a first‐ever acute ischemic stroke. Methods: The study included 899 adult patients ( ≥ 18 years) with confirmed diagnosis of first‐ever acute ischemic stroke enrolled in the Malaysian National Stroke Registry (NSR) from January 2009 to December 2019. The primary outcome was mortality within 90 days post‐stroke (266 events [29.6%]). The prognostic model was developed using logistic regression (75%, n = 674) and internally validated (25%, n = 225). Model performance was assessed using discrimination (area under the curve (AUC]) and calibration (Hosmer‐Lemeshow test [HL]). Results: The final model includes factors associated with increased risk of mortality, such as age (adjusted odds ratio, aOR 1.06 [95% confidence interval, CI 1.03, 1.10; p < 0.001]), National Institutes of Health Stroke Scale (NIHSS) score aOR 1.08 (95% CI 1.08, 1.13; p = 0.004), and diabetes aOR 2.29 (95% CI 1.20, 4.37; p = 0.012). The protective factors were antiplatelet within 48 h. aOR 0.40 (95% CI 0.19, 0.81; p = 0.01), dysphagia screening aOR 0.30 (95% CI 0.15, 0.61; p = 0.001), antiplatelets upon discharge aOR 0.17 (95% CI 0.08, 0.35; p < 0.001), lipid‐lowering therapy aOR 0.37 (95% CI 0.17, 0.82; p = 0.01), stroke education aOR 0.02 (95% CI 0.01, 0.05; p < 0.001) and rehabilitation aOR 0.08 (95% CI 0.04, 0.16; p < 0.001). The model demonstrated excellent performance (discrimination [AUC = 0.94] and calibration [HL, X2 p = 0.63]). Conclusion: The study developed a validated prognostic model that excellently predicts mortality after a first‐ever acute ischemic stroke with potential clinical utility in acute stroke care decision‐making. The predictors could be valuable for creating risk calculators and aiding healthcare providers and patients in making well‐informed clinical decisions during the stroke care process.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/, Start Date: 2025-02-13
Publisher:	Wiley
ISSN:	2398-8835
Date of First Compliant Deposit:	25 February 2025
Date of Acceptance:	27 January 2025
Last Modified:	25 Feb 2025 12:00
URI:	https://orca.cardiff.ac.uk/id/eprint/176469

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