The stroke prognosis instrument II (SPI-II): A clinical prediction instrument for patients with transient ischemia and nondisabling ischemic stroke

Walter N. Kernan, Catherine M. Viscoli, Lawrence M. Brass, Robert W. Makuch, Philip M. Sarrel, Robin S. Roberts, Michael Gent, Peter Rothwell, Ralph L. Sacco, Ruei Che Liu, Bernadette Boden-Albala, Ralph I. Horwitz

Research output: Contribution to journalArticle

Abstract

Background and Purpose - In 1991 we developed the Stroke Prognosis Instrument (SPI-I) to stratify patients with transient ischemic attack or ischemic stroke by prognosis for stroke or death in 2 years. In this article we validate and improve SPI-I (creating SPI-II). Methods - To validate SPI-I, we applied it to 4 test cohorts and calculated pooled outcome rates. To create SPI-II, we incorporated new predictive variables identified in 1 of the test cohorts and validated it in the other 3 cohorts. Results - For SPI- I, pooled rates (all 4 test cohorts) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 24%, respectively (P<0.01, log- rank test). SPI-II was created by adding congestive heart failure and prior stroke to SPI-I. Each patient's risk group was determined by the total score for 7 factors: congestive heart failure (3 points); diabetes (3 points); prior stroke (3 points); age >70 years (2 points); stroke for the index event (not transient ischemic attack) (2 points); hypertension (1 point); and coronary artery disease (1 point). Risk groups I, II, and III comprised patients with 0 to 3, 4 to 7, and 8 to 15 points, respectively. For SPI-I, pooled rates (3 cohorts excluding the SPI-II development cohort) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 23%, respectively. For SPI-II, pooled rates were 10%, 19%, and 31%, respectively. In receiver operator characteristic analysis, the area under the curve was 0.59 (95% CI, 0.57 to 0.60) for SPI-I and 0.63 (95% CI, 0.62 to 0.65) for SPI-II, confirming the better performance of the latter. Conclusions - Compared with SPI-I, SPI-II achieves greater discrimination in outcome rates among risk groups SPI-II is ready for use in research design and may have a role in patient counseling.

Original languageEnglish (US)
Pages (from-to)456-462
Number of pages7
JournalStroke
Volume31
Issue number2
DOIs
StatePublished - Feb 2000

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Keywords

  • Cerebral infarction
  • Cerebral ischemia, transient
  • Cerebrovascular disorders
  • Prognosis
  • Randomized controlled trials

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Kernan, W. N., Viscoli, C. M., Brass, L. M., Makuch, R. W., Sarrel, P. M., Roberts, R. S., Gent, M., Rothwell, P., Sacco, R. L., Liu, R. C., Boden-Albala, B., & Horwitz, R. I. (2000). The stroke prognosis instrument II (SPI-II): A clinical prediction instrument for patients with transient ischemia and nondisabling ischemic stroke. Stroke, 31(2), 456-462. https://doi.org/10.1161/01.STR.31.2.456