Work

Clinical guideline-guided prognostic models of functional disability after acute ischemic stroke: a retrospective cohort study

Year: 2026

Type: article

Abstract: BACKGROUND: There is limited evidence on prognostic models that incorporate clinical guideline recommendations during the acute management of ischemic stroke. This study aimed to develop and validate clinical guideline-based prognostic models of functional disability following a first-ever acute ischemic stroke. METHODS: A multicenter retrospective cohort study was conducted using data from 899 adult patients (aged 18 years or older) with a first-ever acute ischemic stroke, and enrolled in the Malaysian National Stroke Registry (NSR) between January 2009 and December 2019. The primary outcome was functional disability at three months post-discharge, defined as a modified Rankin Scale (mRS) score of 3 to 5. A multivariable logistic regression model was developed using random sampling data splitted into two cohorts: the development (n = 674; 75%) and the internal validation (n = 225; 25%). Model performance was evaluated by discrimination [area under the curve (AUC)] and calibration [Hosmer–Lemeshow (HL) test]. RESULTS: The final prognostic model showed factors associated with increased risk of functional disability include age [adjusted odds ratio (aOR) 1.02, 95% CI 1.00–1.04, p = 0.024], female gender [aOR 1.54, 95% CI 1.06–2.23, p = 0.024], and diabetes [aOR 1.66, 95% CI 1.15–2.40, p = 0.007]. While those factors associated with decreased risk of disability include posterior circulation infarct (POCI) [aOR 0.38, 95% CI 0.18–0.78, p = 0.009], and adherence to key performance indicators (KPIs); antiplatelet therapy [aOR 0.48, 95% CI 0.29–0.80, p = 0.005], lipid-lowering therapy [aOR 0.56, 95% CI 0.37–0.83, p = 0.004], stroke education [aOR 0.09, 95% CI 0.05–0.16, p < 0.001], and rehabilitation [aOR 0.43, 95% CI 0.29–0.64, p < 0.001]. The fitted model demonstrated good discrimination (AUC: 0.803; 95% CI, 0.78–0.83 for development, and 0.777; 95% CI, 0.75–0.81 for validation) and calibration (HL test: p = 0.473 for development, p = 0.967 for validation). CONCLUSION: A clinical guideline-guided prognostic model of functional disability following a first-ever acute ischemic stroke was successfully developed and validated, demonstrating strong performance and potential clinical relevance. This model can help clinicians predict stroke outcomes, guide informed clinical decision-making, and support the development of personalized stroke care.

Source: BMC Neurology

DOI: 10.1186/s12883-025-04432-w