Association Between LACE+ Index Risk Category and 90-Day Mortality After Stroke.

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2025-02-01 Epub Date: 2024-10-08 DOI:10.1212/CPJ.0000000000200363

Adalia Jun-O'Connell, Brian Silver, Eliza Grigoriciuc, Akanksha Gulati, Kimiyoshi J Kobayashi, Nils Henninger

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Abstract

Background and objectives: A higher LACE+ index risk category (defined as LACE+ score ≥78) typically calculated before hospital discharge has been associated with increased risk of unplanned 30-day hospital readmissions and early death after hospital discharge. However, its utility to predict poststroke mortality is unknown. Here, we examined whether the LACE+ index risk category assessed at both discharge (dLACE+) and admission (aLACE+) was associated with 90-day mortality after stroke.

Methods: We retrospectively analyzed 2,729 consecutive patients who presented with ischemic or hemorrhagic strokes, included in an institutional stroke registry between January 2018 and December 2021. The primary outcome of interest was 90-day mortality after the index hospitalization. Patients were categorized as high-risk (≥78), medium-to-high-risk (59-77), and low-to-medium-risk (0-58) according to the LACE+ as automatically calculated at admission and discharge. Analyses were performed on the entire cohort, as well as stratified according to acute ischemic stroke and hemorrhagic stroke diagnosis.

Results: Among patients who completed 90-day follow-up, the mortality rate was 24.3% (576/2368). In the Kaplan-Meier analysis, the high-risk aLACE+ group had the highest 90-day mortality rate as compared with low-to-medium-risk and medium-to-high-risk groups (p < 0.001). In a fully adjusted multivariable Cox-regression, the 90-day hazards of death were significantly greater among participants in a high-risk aLACE+ (aHR 1.7, 95% CI 1.080-2.742, p = 0.022) and medium-to-high-risk aLACE+ categories (aHR 1.4, 95% CI 1.141-1.778, p = 0.002) as compared with participants in the low-to-medium-risk aLACE+ category. Results were overall similar for dLACE+.

Discussion: The LACE+ calculated at both admission and discharge admission identified patients with stroke at increased risk for 90-day mortality. Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death.

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LACE+ 指数风险类别与脑卒中后 90 天死亡率之间的关系。

背景和目的：通常在出院前计算的 LACE+ 指数风险类别（定义为 LACE+ 评分≥78）越高，出院后 30 天非计划再入院和早期死亡的风险就越高。然而，它在预测卒中后死亡率方面的作用尚不清楚。在此，我们研究了出院时（dLACE+）和入院时（aLACE+）评估的 LACE+ 指数风险类别是否与中风后 90 天死亡率相关：我们回顾性分析了2018年1月至2021年12月期间纳入卒中登记机构的2729名连续缺血性或出血性卒中患者。主要研究结果是住院后 90 天的死亡率。根据入院和出院时自动计算的LACE+，患者被分为高危（≥78）、中高危（59-77）和中低危（0-58）。对整个队列进行了分析，并根据急性缺血性卒中和出血性卒中诊断进行了分层：结果：在完成 90 天随访的患者中，死亡率为 24.3%（576/2368）。在 Kaplan-Meier 分析中，与中低风险组和中高风险组相比，高风险 aLACE+ 组的 90 天死亡率最高（p < 0.001）。在完全调整后的多变量 Cox 回归中，与中低风险 aLACE+ 组相比，高风险 aLACE+ 组（aHR 1.7，95% CI 1.080-2.742，p = 0.022）和中高风险 aLACE+ 组（aHR 1.4，95% CI 1.141-1.778，p = 0.002）参与者的 90 天死亡风险明显更高。讨论：讨论：入院和出院时计算的 LACE+ 均可识别出 90 天死亡率风险增加的卒中患者。今后有必要进行研究，以确定基于 LACE+ 评分的风险分层是否可用于设计早期干预措施以降低死亡风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.