Background
Methods
Derivation, internal and external validation cohorts
Data collection and variables definitions
Statistical analysis
Results
Patient characteristics
Derivation cohort | Internal validation cohort | P1value* | External validation cohort | P2value* | |
---|---|---|---|---|---|
(n = 8,820) | (n = 5,882) | (n = 2,938) | |||
Demographics | |||||
Age, y, median (IQR) | 66 (56-74) | 66 (57-75) | 0.11 | 64 (55-72) | <0.001 |
Gender (male), n (%) | 5430 (61.6) | 3675 (62.5) | 0.27 | 1927 (65.5) | <0.001 |
Vascular risk factor, n (%) | |||||
Hypertension | 5601 (63.5) | 3683 (62.6) | 0.27 | 1987 (67.6) | <0.001 |
Diabetes mellitus | 1834 (20.8) | 1287 (21.9) | 0.11 | 720 (24.5) | <0.001 |
Dyslipidemia | 947 (10.7) | 637 (10.8) | 0.86 | 386 (13.1) | <0.001 |
Atrial fibrillation | 643 (7.3) | 415 (7.1) | 0.60 | 175 (6.0) | 0.01 |
Coronary artery disease | 1222 (13.9) | 811 (13.8) | 0.91 | 285 (9.7) | <0.001 |
Peripheral artery disease | 64 (0.7) | 29 (0.5) | 0.08 | 26 (0.9) | 0.39 |
History of stroke/TIA | 2795 (31.7) | 1822 (31.0) | 0.36 | 809 (27.5) | <0.001 |
Smoking | 3510 (39.8) | 2326 (39.5) | 0.70 | 1022 (34.8) | <0.001 |
Heavy alcohol consumption | 1346 (15.3) | 921 (15.7) | 0.55 | 372 (12.7) | <0.001 |
Others coexistent condition, n (%) | |||||
Congestive heart failure | 169 (1.9) | 121 (2.1) | 0.55 | 24 (0.8) | <0.001 |
Valvular heart disease | 213 (2.4) | 139 (2.4) | 0.83 | 40 (1.4) | 0.001 |
COPD | 98 (1.1) | 64 (1.1) | 0.88 | 12 (0.4) | 0.001 |
Hepatic cirrhosis | 29 (0.3) | 21 (0.4) | 0.78 | 7 (0.2) | 0.44 |
Peptic ulcer or previous GIB | 283 (3.2) | 195 (3.3) | 0.72 | 76 (2.6) | 0.09 |
Renal failure | 7 (0.1) | 4 (0.1) | 0.80 | 3 (0.1) | 0.71 |
Arthritis | 266 (3.0) | 176 (3.0) | 0.27 | 45 (1.5) | <0.001 |
Dementia | 113 (1.3) | 82 (1.4) | 0.57 | 18 (0.6) | 0.003 |
Cancer | 150 (1.7) | 109 (1.9) | 0.51 | 54 (1.8) | 0.62 |
Pre-stroke dependence (mRS ≥3), n (%) | 809 (9.2) | 535 (9.1) | 0.87 | 0 (0.0) | <0.001 |
Pre-admission antiplatelet therapy, n (%) | 1449 (16.4) | 932 (15.8) | 0.35 | 357 (12.2) | <0.001 |
Pre-admission anticoagulation therapy, n (%) | 210 (2.4) | 122 (2.1) | 0.22 | 26 (0.9) | <0.001 |
Admission NIHSS score, median (IQR) | 5 (2-9) | 5 (2-9) | 0.68 | 4 (2-8) | 0.02 |
Admission GCS score, median (IQR) | 15 (14-15) | 15 (14-15) | 0.36 | 15 (15-15) | 0.18 |
Admission SBP (mmHg), median (IQR) | 150 (134-163) | 150 (135-162) | 0.88 | 150 (135-167) | 0.22 |
Admission DBP (mmHg), median (IQR) | 89 (80-95) | 89 (80-95) | 0.98 | 90 (80-98) | 0.11 |
OCSP subtype, n (%) | 0.22 | <0.001 | |||
Partial anterior circulation infarct (PACI) | 4834 (54.8) | 3327 (56.6) | 1829 (62.3) | ||
Total anterior circulation infarct (TACI) | 811 (9.2) | 519 (8.8) | 176 (6.0) | ||
Lacunar infarction (LACI) | 1667 (18.9) | 1074 (18.3) | 246 (8.4) | ||
Posterior circulation infarct (POCI) | 1508 (17.1) | 962 (18.4) | 687 (23.4) | ||
Intravenous t-PA within 3 h after onset, n (%) | 108 (1.2) | 73 (1.2) | 0.93 | 137 (4.6) | <0.001 |
Antithrombotic therapy on admission, n (%) | 7371 (83.6) | 4950 (84.2) | 0.35 | 2550 (86.8) | <0.001 |
Anticoagulation therapy on admission, n (%) | 210 (2.4) | 122 (2.1) | 0.24 | 159 (5.4) | <0.001 |
Length of hospital stay (days), median (IQR) | 14 (10-20) | 14 (10-20) | 0.96 | 14 (11-18) | 0.15 |
In-hospital GIB, n (%) | 227 (2.6) | 135 (2.3) | 0.29 | 44 (1.5) | 0.001 |
Predictors of GIB and derivation of the AIS-GIB score
Variables | β-coefficients | adjusted O.R.* | 95% C.I. | P value |
---|---|---|---|---|
Model intercept | -6.529 | |||
Age (years) | 0.009 | 1.01 | 1.00-1.02 | 0.01 |
Gender (male) | 0.370 | 1.45 | 1.13-1.85 | 0.004 |
Hypertension | 0.345 | 1.41 | 1.10-1.82 | 0.008 |
Hepatic cirrhosis | 1.299 | 3.66 | 1.17-11.5 | <0.001 |
Peptic ulcer or previous GIB | 1.226 | 3.41 | 2.28-5.10 | <0.001 |
Pre-stroke dependence (mRS ≥3) | 0.717 | 2.05 | 1.54-2.72 | <0.001 |
Admission NIHSS (per 1 point increase) | 0.063 | 1.07 | 1.04-1.09 | <0.001 |
Admission GCS (per 1 point decrease) | 0.057 | 1.06 | 1.01-1.11 | 0.01 |
OCSP subtype | ||||
Lacunar infarction (LACI) | … | 1.00 | … | … |
Partial anterior circulation infarct (PACI) | 0.169 | 1.18 | 0.80-1.75 | 0.39 |
Total anterior circulation infarct (TACI) | 0.457 | 1.58 | 1.01-2.49 | 0.02 |
Posterior circulation infarct (POCI) | 0.804 | 2.24 | 1.47-3.40 | <0.001 |
Items | Score | Point total | Estimate of risk (%)* |
---|---|---|---|
Age group
| 0 | 0.3 | |
≤ 59 | 0 | 1 | 0.4 |
60-69 | 1 | 2 | 0.6 |
70-79 | 1 | 3 | 1.0 |
≥80 | 2 | 4 | 1.5 |
Gender
| 5 | 2.4 | |
Female | 0 | 6 | 3.7 |
Male | 1 | 7 | 5.7 |
Medical history
| 8 | 8.7 | |
Hypertension | 1 | 9 | 13.0 |
Hepatic cirrhosis | 3 | 10 | 19.0 |
Peptic ulcer or previous GIB | 3 | 11 | 26.8 |
Pre-stroke disability (mRS ≥ 3)
| 2 | 12 | 36.5 |
Admission NIHSS score
| 13 | 47.4 | |
0-4 | 0 | 14 | 58.6 |
5-9 | 1 | 15 | 68.9 |
10-14 | 2 | 16 | 77.7 |
≥15 | 3 | 17 | 84.5 |
Admission GCS score
| 18 | 89.5 | |
15 | 0 | ||
13-14 | 0 | ||
9-12 | 1 | ||
3-8 | 1 | ||
OCSP subtype
| |||
Lacunar infarction (LACI) | 0 | ||
Partial anterior circulation infarct (PACI) | 0 | ||
Total anterior circulation infarct (TACI) | 1 | ||
Posterior circulation infarct (POCI) | 2 |
Internal validation of the AIS-GIB score
External validation of AIS-GIB score
Sensitivity analysis
Derivation cohort | Internal validation cohort | External validation cohort | ||||
---|---|---|---|---|---|---|
(n = 8,820) | (n = 5,882) | (n = 2,938) | ||||
AUROC | 95% C.I. | AUROC | 95% C.I. | AUROC | 95% C.I. | |
Overall cohort | 0.794 | 0.764-0.825 | 0.780 | 0.740-0.820 | 0.755 | 0.710-0.818 |
Subgroups | ||||||
Age | ||||||
≤60 | 0.800 | 0.747-0.854 | 0.778 | 0.707-0.848 | 0.816 | 0.734-0.898 |
≥61 | 0.777 | 0.738-0.815 | 0.771 | 0.720-0.823 | 0.737 | 0.698-0.789 |
Gender | ||||||
Male | 0.797 | 0.757-0.837 | 0.795 | 0.748-0.842 | 0.756 | 0.701-0.829 |
Female | 0.795 | 0.749-0.841 | 0.748 | 0.702-0.819 | 0.740 | 0.698-0.845 |
Length of hospital stay | ||||||
<7 days | 0.786 | 0.730-0.841 | 0.792 | 0.708-0.876 | 0.713 | 0.639-0.786 |
7-14 days | 0.814 | 0.739-0.890 | 0.787 | 0.715-0.880 | 0.731 | 0.679-0.843 |
>14 days | 0.770 | 0.728-0.812 | 0.756 | 0.702-0.809 | 0.725 | 0.699-0.856 |