Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/104969
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Type: Journal article
Title: Validating a predictive model of acute advanced imaging biomarkers in ischemic stroke
Author: Bivard, A.
Levi, C.
Lin, L.
Cheng, X.
Aviv, R.
Spratt, N.
Lou, M.
Kleinig, T.
O'Brien, B.
Butcher, K.
Zhang, J.
Jannes, J.
Dong, Q.
Parsons, M.
Citation: Stroke, 2017; 48(3):645-650
Publisher: Lippincott Williams and Wilkins
Issue Date: 2017
ISSN: 0039-2499
1524-4628
Statement of
Responsibility: 
Andrew Bivard, Christopher Levi, Longting Lin, Xin Cheng, Richard Aviv, Neil J. Spratt, Min Lou, Tim Kleinig, Billy O’Brien, Kenneth Butcher, Jingfen Zhang, Jim Jannes, Qiang Dong, Mark Parsons
Abstract: Background and Purpose: Advanced imaging to identify tissue pathophysiology may provide more accurate prognostication than the clinical measures used currently in stroke. This study aimed to derive and validate a predictive model for functional outcome based on acute clinical and advanced imaging measures. Methods: A database of prospectively collected sub-4.5 hour patients with ischemic stroke being assessed for thrombolysis from 5 centers who had computed tomographic perfusion and computed tomographic angiography before a treatment decision was assessed. Individual variable cut points were derived from a classification and regression tree analysis. The optimal cut points for each assessment variable were then used in a backward logic regression to predict modified Rankin scale (mRS) score of 0 to 1 and 5 to 6. The variables remaining in the models were then assessed using a receiver operating characteristic curve analysis. Results: Overall, 1519 patients were included in the study, 635 in the derivation cohort and 884 in the validation cohort. The model was highly accurate at predicting mRS score of 0 to 1 in all patients considered for thrombolysis therapy (area under the curve [AUC] 0.91), those who were treated (AUC 0.88) and those with recanalization (AUC 0.89). Next, the model was highly accurate at predicting mRS score of 5 to 6 in all patients considered for thrombolysis therapy (AUC 0.91), those who were treated (0.89) and those with recanalization (AUC 0.91). The odds ratio of thrombolysed patients who met the model criteria achieving mRS score of 0 to 1 was 17.89 (4.59-36.35, P<0.001) and for mRS score of 5 to 6 was 8.23 (2.57-26.97, P<0.001). Conclusions: This study has derived and validated a highly accurate model at predicting patient outcome after ischemic stroke.
Keywords: Angiography
area under the curve
basal ganglia
odds ratio
stroke
Rights: © 2017 American Heart Association, Inc.
DOI: 10.1161/STROKEAHA.116.015143
Grant ID: http://purl.org/au-research/grants/nhmrc/1013719
http://purl.org/au-research/grants/nhmrc/1110629
Published version: http://dx.doi.org/10.1161/strokeaha.116.015143
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