Dataset Information

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

ABSTRACT:

Background

Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African.

Objectives

To develop Afrocentric risk-scoring models for stroke occurrence.

Materials and methods

We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off.

Results

For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%).

Conclusions

The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.

SUBMITTER: Akpa O

PROVIDER: S-EPMC8511059 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

Akpa Onoja O Sarfo Fred S FS Owolabi Mayowa M Akpalu Albert A Wahab Kolawole K Obiako Reginald R Komolafe Morenikeji M Owolabi Lukman L Osaigbovo Godwin O GO Ogbole Godwin G Tiwari Hemant K HK Jenkins Carolyn C Fakunle Adekunle G AG Olowookere Samuel S Uvere Ezinne O EO Akinyemi Joshua J Arulogun Oyedunni O Akpalu Josephine J Tito-Ilori Moyinoluwalogo M MM Asowata Osahon J OJ Ibinaiye Philip P Akisanya Cynthia C Oyinloye Olalekan I OI Appiah Lambert L Sunmonu Taofik T Olowoyo Paul P Agunloye Atinuke M AM Adeoye Abiodun M AM Yaria Joseph J Lackland Daniel T DT Arnett Donna D Laryea Ruth Y RY Adigun Taiwo O TO Okekunle Akinkunmi P AP Calys-Tagoe Benedict B Ogah Okechukwu S OS Ogunronbi Mayowa M Obiabo Olugbo Y OY Isah Suleiman Y SY Dambatta Hamisu A HA Tagge Raelle R Ogenyi Obande O Fawale Bimbo B Melikam Chimdinma L CL Onasanya Akinola A Adeniyi Sunday S Akinyemi Rufus R Ovbiagele Bruce B

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 20210728 10

<h4>Background</h4>Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African.<h4>Objectives</h4>To develop Afrocentric risk-scoring models for stroke occurrence.<h4>Materials and methods</h4>We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were rand ...[more]

PMID: 34332227

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Project description:BackgroundSub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa.MethodsThe Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% CIs.FindingsBetween Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men) with mean ages of 59·0 years (SD 13·8) for cases and 57·8 years (13·7) for controls. 1430 (68%) had ischaemic stoke, 682 (32%) had haemorrhagic stroke, and six (<1%) had discrete ischaemic and haemorrhagic lesions. 98·2% (95% CI 97·2-99·0) of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19·36 (95% CI 12·11-30·93) and 90·8% (95% CI 87·9-93·7) for hypertension, 1·85 (1·44-2·38) and 35·8% (25·3-46·2) for dyslipidaemia, 1·59 (1·19-2·13) and 31·1% (13·3-48·9) for regular meat consumption, 1·48 (1·13-1·94) and 26·5% (12·9-40·2) for elevated waist-to-hip ratio, 2·58 (1·98-3·37) and 22·1% (17·8-26·4) for diabetes, 2·43 (1·81-3·26) and 18·2% (14·1-22·3) for low green leafy vegetable consumption, 1·89 (1·40-2·54) and 11·6% (6·6-16·7) for stress, 2·14 (1·34-3·43) and 5·3% (3·3-7·3) for added salt at the table, 1·65 (1·09-2·49) and 4·3% (0·6-7·9) for cardiac disease, 2·13 (1·12-4·05) and 2·4% (0·7-4·1) for physical inactivity, and 4·42 (1·75-11·16) and 2·3% (1·5-3·1) for current cigarette smoking. Ten of these factors were associated with ischaemic stroke and six with haemorrhagic stroke occurrence.InterpretationImplementation of interventions targeting these leading risk factors at the population level should substantially curtail the burden of stroke among Africans.FundingNational Institutes of Health.

Project description:ObjectiveTo validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment.MethodsAfter assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score.ResultsCognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29-4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6-8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9-11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3-4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment).ConclusionThe GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment.Clinicaltrialsgov identifierNCT01339195.

Dataset Information

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

Background

Objectives

Materials and methods

Results

Conclusions

Publications

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

Similar Datasets

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