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Development and validation of risk score to estimate 1-year late poststroke epilepsy risk in ischemic stroke patients

Authors Chi NF, Kuan YC, Huang YH, Chan L, Hu CJ, Liu HY, Chiou HY, Chien LN

Received 14 March 2018

Accepted for publication 16 May 2018

Published 21 August 2018 Volume 2018:10 Pages 1001—1011

DOI https://doi.org/10.2147/CLEP.S168169

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Professor Henrik Toft Sørensen


Nai-Fang Chi,1,2 Yi-Chun Kuan,1–3 Yao-Hsien Huang,1,2 Lung Chan,1,2 Chaur-Jong Hu,1,2,4 Hung-Yi Liu,5 Hung-Yi Chiou,6 Li-Nien Chien7

1Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China; 2Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China; 3Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; 4PhD Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, Republic of China; 5Health and Clinical Research Data Center, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China; 6School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China; 7School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan, Republic of China

Objective: This study aimed to develop and validate a prognostic model for the 1-year risk of late poststroke epilepsy (PSE).
Materials and methods: We included patients initially diagnosed with ischemic stroke between 2003 and 2014 in a National Health Insurance claims-based cohort in Taiwan. Patients were further divided into development and validation cohorts based on their year of stroke diagnosis. Multivariable Cox regression with backward elimination was used to analyze the association between 1-year PSE and risk factors before and on stroke admission.
Results: In total, 1,684 (1.93%) and 725 (1.87%) ischemic stroke patients comprising the development and validation cohorts, respectively, experienced late PSE within 1 year after stroke. Seven clinical variables were examined to be independently associated with 1-year risk of PSE. We developed a risk score called “PSEiCARe” ranging from 0 to 16 points, comprising the following factors: prolonged hospital stay (>2 weeks, 1 point), seizure on admission (6 points), elderly patients (age ≥80 years, 1 point), intensive care unit stay on admission (3 points), cognitive impairment (dementia, 2 points), atrial fibrillation (2 points), and respiratory tract infection (pneumonia) on admission (1 point). Patients were further classified into low-, medium-, high-, and very-high-risk groups. The incidence (per 100 person-years) was 0.64 (95% CI: 0.56–0.71) for the low-risk, 2.62 (95% CI: 2.43–2.82) for the medium-risk, 10.3 (95% CI: 9.48–11.3) for the high-risk, and 28.2 (95% CI: 24.0–33.0) for the very-high-risk groups. Discrimination and calibration were satisfactory, with a Harrell’s C of 0.762 in the development model and 0.792 in the validation model.
Conclusion: PSEiCARe is an easy-to-use prognostic score that integrates patient characteristics and clinical factors on stroke admission to predict 1-year PSE risk; it has the potential to assist individualized patient management and improve clinical practice, thereby preventing the occurrence of late PSE.

Keywords: poststroke epilepsy, prediction model, risk score, population-based, claim analysis

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