Modified Rankin Scale disability status at day 4 poststroke is an informative predictor of long-term day 90 outcome

J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107902. doi: 10.1016/j.jstrokecerebrovasdis.2024.107902. Epub 2024 Jul 29.

Abstract

Background: Long-term disability after stroke is standardly assessed 3 months post-onset, using the modified Rankin Scale (mRS). The value of an early, day 4 mRS assessment for projecting the 3-month disability outcome has not been formally investigated.

Methods: In this cohort of patients with acute cerebral ischemia and intracranial hemorrhage, we analyzed day 4 and day 90 mRS assessments in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) Phase 3 trial. The performance of day 4 mRS, alone and as part of multivariate models, in predicting day 90 mRS was assessed using correlation coefficients, percent agreement, and the kappa statistics.

Results: Among the 1573 acute cerebrovascular disease (ACVD) patients, 1206 (76.7%) had acute cerebral ischemia (ACI), while 367 (23.3%) had intracranial hemorrhage. Among all 1573 ACVD patients, day 4 mRS and day 90 mRS correlated strongly, Spearman's rho=0.79, in unadjusted analysis with weighted kappa of 0.59. For dichotomized outcomes, simple carry-forward of the day 4 mRS performed fairly well in agreeing with day 90 mRS: mRS 0-1 (kappa=0.67), 85.4%; mRS 0-2 (k=0.59), 79.5%; fatal outcome, 88% (k=0.33). Correlations of 4d and 90d mRS were stronger for ACI than ICH patients, 0.76 vs 0.71.

Conclusions: In this acute cerebrovascular disease patient cohort, assessment of global disability performed on day 4 is highly informative regarding long-term, 3-month mRS disability outcome, alone, and even more strongly in combination with baseline prognostic variables. The day 4 mRS is a useful measure for imputing the final patient disability outcome in clinical trials and quality improvement programs.

Keywords: Acute cerebrovascular disease; Acute ischemic stroke; Cerebral ischemia; Disability; Intracranial hemorrhage; Modified Rankin Scale (mRS); NIHSS; Outcome; Stroke; intracerebral hemorrhage.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Disability Evaluation*
  • Female
  • Functional Status*
  • Hemorrhagic Stroke / diagnosis
  • Hemorrhagic Stroke / etiology
  • Hemorrhagic Stroke / mortality
  • Hemorrhagic Stroke / physiopathology
  • Hemorrhagic Stroke / therapy
  • Humans
  • Ischemic Stroke / diagnosis
  • Ischemic Stroke / mortality
  • Ischemic Stroke / physiopathology
  • Ischemic Stroke / therapy
  • Magnesium
  • Male
  • Middle Aged
  • Predictive Value of Tests*
  • Randomized Controlled Trials as Topic
  • Recovery of Function*
  • Time Factors
  • Treatment Outcome
  • United States

Substances

  • Magnesium