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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(02): 107-111
DOI: 10.1055/s-0042-1758397
Original Article

IScore, a useful prognostic tool for patients with acute ischemic stroke treated with intravenous thrombolysis: a validation study

IScore, uma ferramenta prognóstica útil para pacientes com AVC isquêmico submetidos a trombólise: estudo de validação
Valéria Cristina Scavasine 
1   Universidade Federal do Paraná, Hospital de Clínicas, Divisão de Neurologia, Curitiba PR, Brasil.
,
Rebeca Teixeira Costa 
1   Universidade Federal do Paraná, Hospital de Clínicas, Divisão de Neurologia, Curitiba PR, Brasil.
,
Viviane de Hiroki Flumignan Zétola 
1   Universidade Federal do Paraná, Hospital de Clínicas, Divisão de Neurologia, Curitiba PR, Brasil.
,
Marcos Christiano Lange 
1   Universidade Federal do Paraná, Hospital de Clínicas, Divisão de Neurologia, Curitiba PR, Brasil.
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Abstract

Background Stroke is one of the major causes of disability and mortality worldwide. Up to 30% of individuals who experience stroke die within 30 days, and more than 50% of those who survive will have some degree of disability. There are some predetermining factors based on admission data that could be used to objectively assess the odds of poor outcomes, including the Ischemic Stroke Predictive Risk Score (IScore).

Objective To analyze and validate the IScore in patients undergoing intravenous thrombolysis for stroke and compare the results of this predictor with actual death and disability outcomes.

Methods In a retrospective study, data were collected from a database housed at the Stroke Unit of the Teaching Hospital of Universidade Federal do Paraná, Southern Brazil. The IScore was applied to admission data from 239 patients, and the results were compared with actual outcomes (death and disability) within 30 days and 1 year after the stroke event. Data analysis was performed using an analysis of the receiver operating characteristic (ROC) curve to determine the sensitivity and specificity of the IScore in the study population.

Results The IScore demonstrated moderate sensitivity and high specificity in patients with stroke who underwent thrombolysis when evaluated after 30 days and 1 year of the event.

Conclusions The IScore can be applied to in stroke patients undergoing thrombolysis; therefore, it may be used as an objective prognostic tool to guide clinical decision-making. Understanding the prognosis of patients in the acute phase can assist clinicians in making the best therapeutic decisions and enable better end-of-life care.

Resumo

Antecedentes O acidente vascular cerebral (AVC) é uma das principais causas de morte e incapacidade no mundo. Até 30% dos indivíduos evoluem a óbito nos primeiros 30 dias. Dos sobreviventes, mais da metade ficam com alguma sequela. Certas variáveis identificadas já na admissão podem sinalizar maior risco de desfecho desfavorável. Uma dessas ferramentas prognósticas é a Escala de Previsão de Riscos de AVC Isquêmico (Ischemic Stroke Predictive Risk Score, IScore, em inglês).

Objetivo Analisar e validar a aplicação do IScore em pacientes com AVC isquêmico submetidos a trombólise endovenosa e comparar os resultados obtidos com a aplicação da escala aos verdadeiros desfechos de morte e incapacidade funcional.

Métodos Trata-se de um estudo retrospectivo, cujos dados foram obtidos do banco de dados da Unidade de AVC do Hospital de Clínicas da Universidade Federal do Paraná. A IScore foi aplicada conforme os dados de admissão de 239 pacientes. Os pacientes foram acompanhados ambulatorialmente, e os resultados da escala foram comparados aos desfechos reais de mortalidade e incapacidade. Os resultados foram demonstrados por meio da curva característica de operação do receptor (receiver operating characteristic, ROC, em inglês) para determinar sensibilidade e especificidade da escala.

Resultados Em pacientes com AVC submetidos a trombólise, a IScore demonstrou moderada sensibilidade e alta especificidade para predizer desfechos tanto de óbito quanto de incapacidade, nos intervalos de 30 dias e 1 ano após o evento.

Conclusões A IScore pode ser aplicada em pacientes com AVC isquêmico, na população específica submetida a trombólise; portanto, pode ser usada como uma ferramenta prognóstica útil, que pode guiar decisões terapêuticas. Entender o prognóstico de paciente na fase aguda pode auxiliar os clínicos a fazer as melhores decisões terapêuticas e possibilitar melhores cuidados ao fim da vida.

Keywords

Cerebrovascular Disorders - Ischemic Stroke - Thrombolytic Therapy - Validation Study - Prognosis

Palavras-chave

Transtornos Cerebrovasculares - AVC Isquêmico - Terapia Trombolítica - Estudo de Validação - Prognóstico

Authors' Contributions

VCS: project administration, database organization, analysis and interpretation of results, writing of the original draft and submission of the article; RTC: project administration, database organization, data curation, initial data analysis; VHFZ: supervision, review and editing of the writing; MCL: creation of database, study conceptualization, establishment of methodological guidelines for the study, discussion of results, review and editing of the writing.




Publication History

Received: 17 February 2022

Accepted: 05 July 2022

Article published online:
22 March 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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