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The related main theme: A. Stroke and Cerebral vascular disorders

THE DISCRIMINATION PERFORMANCE OF THE PREMISE SCORE AFTER ADDITION OF RECURRENT STROKE VARIABLE TO PREDICTING EARLY MORTALITY IN ACUTE ISCHEMIC STROKE PATIENTS

Authers:

Engki  Irawan, MD 1, 2, 3 , 
1 Engki Irawan
2 Iskandar Nasution
3 Haflin Soraya Hutagalung
Corresponding Author:

Engki  Irawan

keywords: Early mortality, PREMISE score, Ischemic stroke
Abstract for original article

OBJECTIVES /BACKGROUND:
Stroke is a major concern in public health and is a leading cause of death and disability throughout theworld. Information on predictors of early stroke mortality is scarce but often requested in clinical practice. A simple score was proposed recently for Predicting Early Mortality from Ischemic Stroke (PREMISE) derived from the Austrian Stroke Unit Registry. Internal validation assigned by Haji Adam Malik General Hospital Medan in 2020 stated that the performance of its discrimination was not strong enough, leads to a further necessity for an improvement by an addition of another predictor variable to improve the discrimination performance of the PREMISE score. This study aims to assess the discrimination performance of the PREMISE score after addition of recurrent stroke variable to predicting early mortality in acute ischemic stroke patients.

MATERIAL and METHOD:
This study was performed as a retrospective cohort study in a population of ischemic stroke patients admitted to Haji Adam Malik General Hospital Medan from January to December 2019. The variables assessed were age, pre-existing disability, and stroke severity which assessed with a National Institutes of Health Stroke Scale (NIHSS), vascular disease, posterior circulation syndrome and non-lacunar causes of stroke as well as additional variables for recurrent stroke. The strength of discrimination is assessed by calculating the area under the curve (AUC) from the Receiver Operating Characteristic (ROC) curve.

RESULT:
In total, 223 ischemic stroke patients were included in the analysis (mean age: 60.48 ± 12.12, 52.9% male). There were 69 patients with recurrent stroke (30.9%). The ischemic stroke mortality rate in 2019 was 46 people (20.6%), of which 22 (9.9%) experienced early death. The PREMISE score showed good calibration (Hosmer-Lemeshow p = .331) and a strong enough discrimination power with an AUC value of 0.783. The addition of the recurrent stroke variable to the PREMISE score showed an increase in AUC 0.806.

DISCUSSION:
The PREMISE score after the addition of the recurrent stroke variable showed an increase the discrimination performance to predicting early mortality in acute ischemic stroke patients.


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