Background: The time point generally recognized as most appropriate to assess final functional outcome after acute ischemic stroke is 3 months. However, identifying earlier reliable prognostic time points may allay patient anxiety about the recovery process, enable assignment of outcome in patients lost to follow-up, and provide earlier and more readily available options for clinical outcome assessment in adaptive design and proof of concept studies. We assessed whether day-7/10 functional outcome predicted day-90 functional outcome among acute ischemic stroke patients. Methods: The NINDS-tPA Study database was analyzed. Global disability was assessed using the modified Rankin Scale (mRS). Spearman correlation evaluated the association of day-7/10 versus day-90 mRS, and observed agreement was computed using the weighted κ agreement, both unadjusted and adjusted by multivariable ordinal logistic modeling for demographic and clinical variables known to influence stroke outcomes. Results: 581 subjects (93%) were alive at 7–10 days. There was strong correlation between mRS score at day 7/10 and day 90 (r = 0.81, p < 0.0001), and the weighted κ agreement was 0.82 (p < 0.0001). In multivariable analysis, day-7/10 day mRS was independently and strongly associated with day-90 mRS, while among other baseline variables, only baseline NIH Stroke Scale score (per unit increase) and a history of congestive heart failure (CHF) were significantly associated with a worse day-90 mRS. Conclusions: Global disability status 1 week after an index ischemic stroke strongly predicts final 3-month disability outcome. Functioning at 1 week, supplemented by initial stroke severity and CHF history information, may provide an early outcome guide useful for patient and family counseling.

Keywords:
Outcomes, Ischemic stroke, Functional measures, Prediction, Disability, Prognosis, Calculator
1.
Roberts L, Counsell C: Assessment of clinical outcomes in acute stroke trials. Stroke 1998;29:986–991.
2.
Duncan PW, Jorgensen HS, Wade DT: Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice. Stroke 2000;31:1429–1438.
3.
Savitz SI, Benatar M, Saver JL, Fisher M: Outcome analysis in clinical trial design for acute stroke: physicians’ attitudes and choices. Cerebrovasc Dis 2008;26:156–162.
4.
Woldag H, Gerhold LL, de Groot M, Wohlfart K, Wagner A, Hummelsheim H: Early prediction of functional outcome after stroke. Brain Inj 2006;20:1047–1052.
5.
Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200–215.
6.
Bonita R, Beaglehole R: Recovery of motor function after stroke. Stroke 1988;19:1497–1500.
7.
Kasner SE: Clinical interpretation and use of stroke scales. Lancet Neurol 2006;5:603–612.
8.
Weimar C, Kurth T, Kraywinkel K, et al: Assessment of functioning and disability after ischemic stroke. Stroke 2002;33:2053–2059.
9.
Lai SM, Duncan PW: Stroke recovery profile and the Modified Rankin assessment. Neuroepidemiology 2001;20:26–30.
10.
Banks JL, Marotta CA: Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 2007;38:1091–1096.
11.
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581–1587.
12.
Brown D, Johnston, KC, Wagner, DP, Haley, EC: Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke. Stroke 2004;35:147–150.
13.
Kent D, Price, LL, Ringleb, P, Hill, MD, Selker HP: Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke 2005;36:62–65.
14.
Frankel MR, Morgenstern LB, Kwiatkowski T, et al: Predicting prognosis after stroke: a placebo group analysis from the national institute of neurological disorders and stroke rt-PA stroke trial. Neurology 2000;55:952–959.
15.
Johnston KC, Wagner DP, Haley EC, Connors AF: Combined clinical and imaging information as an early stroke outcome measure. Stroke 2002;33:466–472.
16.
Brown DL, Johnston KC, Wagner DP, Haley EC: Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke. Stroke 2004;35:147–150.
17.
Hill MD, Kent DM, Hinchey J, et al: Sex-based differences in the effect of intra-arterial treatment of stroke: analysis of the PROACT-2 study. Stroke 2006;37:2322–2325.
18.
Kent DM, Price LL, Ringleb P, Hill MD, Selker HP: Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke 2005;36:62–65.
19.
Arsava EM, Rahman R, Rosand J, et al: Severity of leukoaraiosis correlates with clinical outcome after ischemic stroke. Neurology 2009;72:1403–1410.
20.
Bruno A, Levine SR, Frankel MR, et al: Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology 2002;59:669–674.
21.
Bruno A, Biller J, Adams HP, et al: Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology 1999;52:280–284.
22.
Saver JL: Novel end point analytic techniques and interpreting shifts across the entire range of outcome scales in acute stroke trials. Stroke 2007;38:3055–3062.
23.
Quinn TJ, Dawson J, Walters MR, Lees KR: Variability in modified Rankin scoring across a large cohort of international observers. Stroke 2008;39:2975–2979.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.