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Open Access Research article

Evaluation of IScore validity in a Greek cohort of patients with type 2 diabetes

Vasileios Dragoumanos1, Konstantinos N Tzirogiannis1, Georgios I Panoutsopoulos2*, Konstantinos Krikonis3, Evangelos Fousteris1, Maria Vourvou4, Georgios Elesnitsalis4, Nikolaos Melas5, Kalliopi T Kourentzi6 and Andreas Melidonis1

  • * Corresponding author: Georgios I Panoutsopoulos gpanouts@uop.gr

  • † Equal contributors

Author Affiliations

1 Diabetes Center, “Tzanio” General Hospital of Piraeus, Piraeus, Greece

2 Department of Nursing, Faculty of Human Movement and Quality of Life Science, University of Peloponnese, Sparta, Lakonia, Greece

3 Mathematics Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

4 Intensive Care Unit, “Papageorgiou” General Hospital of Thessaloniki, Thessaloniki, Greece

5 1st Internal Medicine Department, “Tzanio” General Hospital of Piraeus, Piraeus, Greece

6 Medical School, University of Ioannina, Ioannina, Greece

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BMC Neurology 2013, 13:121  doi:10.1186/1471-2377-13-121

Published: 16 September 2013

Abstract

Background

Diabetes constitutes a risk factor for stroke that also aggravates stroke prognosis. Several prognostic models have been developed for the evaluation of neurologic status, severity, short-term functional outcome and mortality of stroke patients. IScore is a novel tool recently developed in order to predict mortality rates within 30 days and 1 year after ischemic stroke and diabetes is not included in the scoring scale of IScore. The aim of the present study was to evaluate and compare IScore validity in ischemic stroke patients with and without diabetes.

Methods

This prospective study included 312 consecutive Caucasian patients with type 2 diabetes and 222 Caucasian patients without diabetes admitted for ischemic stroke in a tertiary Greek hospital. Thirty-day and 1-year IScores were individually calculated for each patient and actual mortality was monitored at the same time intervals. IScore’s predictive ability and calibration was evaluated and compared for ischemic stroke patients with and without diabetes. The performance of IScore for predicting 30 and 1-year mortality between patients with and without diabetes was assessed by determining the calibration and discrimination of the score. The area under the receiver operating characteristic curve was used to evaluate the discriminative ability of IScore for patients with and without diabetes, whereas the calibration of IScore was assessed by the Hosmer–Lemeshow goodness-of fit statistic.

Results

Baseline population characteristics and mortality rates did not differ significantly for both cohorts. IScore values were significantly higher for patients with diabetes at 30 days and 1 year after ischemic stroke and patients with diabetes presented more frequently with lacunar strokes. Based on ROC curves analysis IScore’s predictive ability for 30 day mortality was excellent, without statistically significant difference, for both cohorts. Predictive ability for 1 year mortality was also excellent for both groups with significantly better ability for patients with diabetes especially at high score values. Calibration of the model was good for both groups of patients.

Conclusions

IScore accurately predicts mortality in acute ischemic stroke Caucasian patients with and without diabetes with higher efficacy in predicting 1 year mortality in patients with diabetes especially with high scores.

Keywords:
IScore; Stroke; Ischemic stroke; Ischemic stroke mortality; Diabetes