Validation of 10-Year Stroke Prediction Scores in a Community-Based Cohort of Chinese Older Adults

Frontiers in Neurology

Jianhua Cheng¹  Yanlei Zhang¹  Chunxiu Wang²  Xiaoguang Wu²  Xianghua Fang²  Hongjun Liu²  Shaochen Guan²  Chunxiao Liu³  Xiang Gu⁴  Zhongying Zhang⁵ 

[1] Department of Neurology, the First affiliated Hospital of Wenzhou Medical University, Wenzhou, China;Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China;Geriatric Department, Beijing Geriatric Hospital, Beijing, China;Geriatric Department, Friendship Hospital, Capital Medical University, Beijing, China;Geriatric Department, Xuanwu Hospital, Capital Medical University, Beijing, China;

关键词: stroke;    risk factors;    prediction score;    primary prevention;    cohort study;   

DOI  :  10.3389/fneur.2020.00986

来源: DOAJ

【 摘 要 】

A stroke prediction model based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project was developed. We compared its predictive ability with the revised Framingham Stroke Risk Score (R-FSRS) for 5-year stroke incidence in a community cohort of Chinese adults, namely the Beijing Longitudinal Study of Aging (BLSA). Calibration, discrimination, and recalibration were used to compare the predictive ability between the two prediction models. Category-less net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values were also assessed. During a mean follow-up duration of 5.1 years, 106 incidents of fatal or non-fatal strokes occurred among 1,203 participants aged 55–84 years. The R-FSRS applied to our cohort underestimated the 5-year risk for stroke in men and women. China-PAR performed better than the R-FSRS in terms of calibration (men, R-FSRS: χ2-value 144.2 [P < 0.001], China-PAR: 10.4 [P = 0.238]; women, R-FSRS: 280.1 [P < 0.001], China-PAR: 12.5 [P = 0.129]). In terms of discrimination, R-FSRS and China-PAR models performed modestly in our cohort (C-statistic 0.603 [95% CI: 0.560–0.644] for men using China-PAR and 0.568 [95% CI: 0.524–0.610] using the R-FSRS; the corresponding numbers for women were 0.602 [95% CI: 0.564–0.639] and 0.575 [95% CI: 0.537–0.613). The recalibrated China-PAR model significantly improved the discrimination in C statistics and produced higher category-less NRI and IDI for stroke incidence than the R-FSRS. Although China-PAR fairly estimated stroke risk in our cohort, it did not sufficiently identify adults at high risk of stroke. Caution would be exercised by practitioners in applying the original China-PAR to Chinese older adults. Further studies are needed to develop an adequate prediction model based on the recalibrated China-PAR or to find new risk markers which could upgrade this model.

【 授权许可】

Unknown