Correlation between the iScore scale and mortality in patients with ischemic cerebrovascular events: A study conducted in Guayaquil, Ecuador
DOI:
https://doi.org/10.61708/y3g0wf04Keywords:
ischemic stroke, prognosis, mortality, validation studyAbstract
Introduction: Cerebrovascular accident (CVD) is the second leading cause of disability and death worldwide. Several prognostic scores have been developed to predict functional outcomes after the event. The ischemic stroke predictive risk score (iScore) estimates the risk of death after hospitalization for an ischemic stroke. Objective: To describe the correlation between the iScore score and mortality in patients with ischemic stroke from Guayaquil, Ecuador. Methodology: Cross-sectional, non-experimental, prospective, quantitative study. It was carried out in the Neurology service of the Luis Vernaza Hospital, in the city of Guayaquil-Ecuador, during the period March-August 2023; Individuals who come to the emergency room with a confirmed diagnosis of ischemic stroke. Data was obtained from the electronic medical record regarding clinical-epidemiological variables and the iScore score was applied. The analysis was performed with SPSS Statistical Software version 24, applying statistical methods of frequency, percentage and association according to the proposed objectives. Results: A sample of 110 individuals was included. The average age of individuals with CVD was 70 years, with a predominance of males (52.7%). Among the most frequent comorbidities were arterial hypertension (72.7%), diabetes mellitus (37.3%) and atrial fibrillation (91%). The mortality rate was 127 per 1000 individuals. Statistical significance was found for those with elevated iScore (fifth quintile) with respect to mortality (p <0.001) (Table 1 and 2). Conclusions: This tool could be used as part of the initial assessment of mortality risk in patients with ischemic CVD.
Downloads
References
GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-58. https://doi.org/10.1016/S1474-4422(19)30034-1 DOI: https://doi.org/10.1016/S1474-4422(19)30034-1
Wang WY, Sang WW, Jin D, Yan SM, Hong Y, Zhang H, et al. The Prognostic Value of the iScore, the PLAN Score, and the ASTRAL Score in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2017;26(6):1233-8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.01.013 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.01.013
Saini V, Guada L, Yavagal DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology. 2021;97(20_Supplement_2):S6-16. https://doi.org/10.1212/WNL.0000000000012781 DOI: https://doi.org/10.1212/WNL.0000000000012781
Campbell BCV, Khatri P. Stroke. Lancet Lond Engl. 2020;396(10244):129-42. https://doi.org/10.1016/S0140-6736(20)31179-X DOI: https://doi.org/10.1016/S0140-6736(20)31179-X
Saposnik G, Kapral MK, Liu Y, Hall R, O'Donnell M, Raptis S, et al. IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke. Circulation. 2011;123(7):739-49. https://doi.org/10.1161/CIRCULATIONAHA.110.983353 DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.983353
Béjot Y, Jacquin A, Daubail B, Durier J, Giroud M. Population-Based Validation of the iScore for Predicting Mortality and Early Functional Outcome in Ischemic Stroke Patients. Neuroepidemiology. 2013;41(3-4):169-73. https://doi.org/10.1159/000354634 DOI: https://doi.org/10.1159/000354634
Zhang N, Liu G, Zhang G, Fang J, Wang Y, Zhao X, et al. External validation of the iScore for predicting ischemic stroke mortality in patients in China. Stroke. 2013;44(7):1924-9. https://doi.org/10.1161/STROKEAHA.111.000172 DOI: https://doi.org/10.1161/STROKEAHA.111.000172
Gao MM, Wang J, Saposnik G. The Art and Science of Stroke Outcome Prognostication. Stroke. 2020;51(5):1358-60. https://doi.org/10.1161/STROKEAHA.120.028980 DOI: https://doi.org/10.1161/STROKEAHA.120.028980
Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM, et al. Global Stroke Statistics 2019. Int J Stroke Off J Int Stroke Soc. 2020;15(8):819-38. https://doi.org/10.1177/1747493020909545 DOI: https://doi.org/10.1177/1747493020909545
Kammersgaard LP, Jørgensen HS, Reith J, Nakayama H, Pedersen PM, Olsen TS, et al. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004;33(2):149-54. https://doi.org/10.1093/ageing/afh052 DOI: https://doi.org/10.1093/ageing/afh052
Rosengren A, Giang KW, Lappas G, Jern C, Torén K, Björck L. Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010. Stroke. 2013;44(9):2388-93. https://doi.org/10.1161/STROKEAHA.113.001170 DOI: https://doi.org/10.1161/STROKEAHA.113.001170
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-596.
Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke. 2009;40(4):1032-7. https://doi.org/10.1161/STROKEAHA.108.542894 DOI: https://doi.org/10.1161/STROKEAHA.108.542894
Westerlind E, Hörsell D, Persson HC. Different predictors after stroke depending on functional dependency at discharge: a 5-year follow up study. BMC Neurol. 2020;20(1):263. https://doi.org/10.1186/s12883-020-01840-y DOI: https://doi.org/10.1186/s12883-020-01840-y
Sennfält S, Norrving B, Petersson J, Ullberg T. Long-Term Survival and Function After Stroke: A Longitudinal Observational Study From the Swedish Stroke Register. Stroke. 2019;50(1):53-61. https://doi.org/10.1161/STROKEAHA.118.022913 DOI: https://doi.org/10.1161/STROKEAHA.118.022913
Markle-Reid M, Fisher K, Walker KM, Beauchamp M, Cameron JI, Dayler D, et al. The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial. BMC Geriatr. 2023;23(1):687. https://doi.org/10.1186/s12877-023-04403-1 DOI: https://doi.org/10.1186/s12877-023-04403-1
Fischer U, Arnold M, Nedeltchev K, Schoenenberger RA, Kappeler L, Höllinger P, et al. Impact of comorbidity on ischemic stroke outcome. Acta Neurol Scand. 2006;113(2):108-13. https://doi.org/10.1111/j.1600-0404.2005.00551.x DOI: https://doi.org/10.1111/j.1600-0404.2005.00551.x
Liu J, Li X, Qu J. Risk factors for acute ischemic stroke in patients with type 2 diabetes mellitus. Medicine (Baltimore). 2023;102(47):e36114. https://doi.org/10.1097/MD.0000000000036114 DOI: https://doi.org/10.1097/MD.0000000000036114
Ekker MS, Verhoeven JI, Schellekens MMI, Boot EM, van Alebeek ME, Brouwers PJAM, et al. Risk Factors and Causes of Ischemic Stroke in 1322 Young Adults. Stroke. 2023;54(2):439-47. https://doi.org/10.1161/STROKEAHA.122.040524 DOI: https://doi.org/10.1161/STROKEAHA.122.040524
Tsai CF, Sudlow CLM, Anderson N, Jeng JS. Variations of risk factors for ischemic stroke and its subtypes in Chinese patients in Taiwan. Sci Rep. 2021;11(1):9700. https://doi.org/10.1038/s41598-021-89228-x DOI: https://doi.org/10.1038/s41598-021-89228-x
Chiu JF, Bell AD, Herman RJ, Hill MD, Stewart JA, Cohen EA, et al. Cardiovascular risk profiles and outcomes of Chinese living inside and outside China. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. 2010;17(6):668-75. https://doi.org/10.1097/HJR.0b013e328339eb74 DOI: https://doi.org/10.1097/HJR.0b013e328339eb74
Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson CS, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019;18(4):394-405. https://doi.org/10.1016/S1474-4422(18)30500-3 DOI: https://doi.org/10.1016/S1474-4422(18)30500-3
Jackson CA, Hutchison A, Dennis MS, Wardlaw JM, Lindgren A, Norrving B, et al. Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke. 2010;41(4):624-9. https://doi.org/10.1161/STROKEAHA.109.558809 DOI: https://doi.org/10.1161/STROKEAHA.109.558809
Tsai CF, Anderson N, Thomas B, Sudlow CLM. Risk factors for ischemic stroke and its subtypes in Chinese vs. Caucasians: Systematic review and meta-analysis. Int J Stroke Off J Int Stroke Soc. 2015;10(4):485-93. https://doi.org/10.1111/ijs.12508 DOI: https://doi.org/10.1111/ijs.12508
Johansen MC, Chen J, Schneider ALC, Carlson J, Haight T, Lakshminarayan K, et al. Association Between Ischemic Stroke Subtype and Stroke Severity: The Atherosclerosis Risk in Communities Study. Neurology. 2023;101(9):e913-21. https://doi.org/10.1212/WNL.0000000000207535 DOI: https://doi.org/10.1212/WNL.0000000000207535
Nilanont Y, Komoltri C, Saposnik G, Côté R, Di Legge S, Jin Y, et al. The Canadian Neurological Scale and the NIHSS: development and validation of a simple conversion model. Cerebrovasc Dis Basel Switz. 2010;30(2):120-6. https://doi.org/10.1159/000314715 DOI: https://doi.org/10.1159/000314715
Mattishent K, Kwok CS, Mahtani A, Pelpola K, Myint PK, Loke YK. Prognostic indices for early mortality in ischaemic stroke - meta-analysis. Acta Neurol Scand. 2016;133(1):41-8. https://doi.org/10.1111/ane.12421 DOI: https://doi.org/10.1111/ane.12421
Kim YD, Choi HY, Jung YH, Yoo J, Nam HS, Song D, et al. The Ischemic Stroke Predictive Risk Score Predicts Early Neurological Deterioration. J Stroke Cerebrovasc Dis. 2016;25(4):819-24. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.003 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.003
Saposnik G, Raptis S, Kapral MK, Liu Y, Tu JV, Mamdani M, et al. The iScore predicts poor functional outcomes early after hospitalization for an acute ischemic stroke. Stroke. 2011;42(12):3421-8. https://doi.org/10.1161/STROKEAHA.111.623116 DOI: https://doi.org/10.1161/STROKEAHA.111.623116
Sung SF, Chen YW, Hung LC, Lin HJ. Revised iScore to predict outcomes after acute ischemic stroke. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2014;23(6):1634-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.010 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.010
Dragoumanos V, Tzirogiannis KN, Panoutsopoulos GI, Krikonis K, Fousteris E, Vourvou M, et al. Evaluation of IScore validity in a Greek cohort of patients with type 2 diabetes. BMC Neurol. 2013;13:121. https://doi.org/10.1186/1471-2377-13-121 DOI: https://doi.org/10.1186/1471-2377-13-121
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Gaceta Médica de la Junta de Beneficencia de Guayaquil
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
