Prognostic indices for early mortality in ischaemic stroke – meta-analysis

K. Mattishent, C. S. Kwok, A. Mahtani, K. Pelpola, P. K. Myint, Y. K. Loke

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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Objectives: Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. Methods: We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003 and 2014) used in predicting early mortality (<6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic curve (AUROC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways and missing data. Results: We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for meta-analysis. Most studies were either retrospective, or post hoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82–0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE – these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78–0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72–0.72) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84–0.87). Conclusions: Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base.
Original languageEnglish
Pages (from-to)41-48
Number of pages8
JournalActa Neurologica Scandinavica
Issue number1
Early online date13 May 2015
Publication statusPublished - Jan 2016


  • mortality
  • prognostic scores
  • risk prediction model
  • stroke

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