Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults
<p><strong>Background: </strong>Reliable classification of ischemic stroke (IS) etiological subtypes is required in research and clinical practice, but the predictive properties of these subtypes in population studies with incomplete investigations are poorly understood.&l...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
SAGE Publications
2023
|
| _version_ | 1797110798218166272 |
|---|---|
| author | Chun, M Qin, H Turnbull, I Sansome, S Gilbert, S Hacker, A Wright, N Zhu, T Clifton, D Bennett, D Guo, Y Pei, P Lv, J Yu, C Yang, L Li, L Lu, Y Chen, Z Cairns, BJ Chen, Y Clarke, R |
| author2 | China Kadoorie Biobank Collaborative Group |
| author_facet | China Kadoorie Biobank Collaborative Group Chun, M Qin, H Turnbull, I Sansome, S Gilbert, S Hacker, A Wright, N Zhu, T Clifton, D Bennett, D Guo, Y Pei, P Lv, J Yu, C Yang, L Li, L Lu, Y Chen, Z Cairns, BJ Chen, Y Clarke, R |
| author_sort | Chun, M |
| collection | OXFORD |
| description | <p><strong>Background: </strong>Reliable classification of ischemic stroke (IS) etiological subtypes is required in research and clinical practice, but the predictive properties of these subtypes in population studies with incomplete investigations are poorly understood.</p>
<p><strong>Aims: </strong>To compare the prognosis of etiologically classified IS subtypes and use machine learning (ML) to classify incompletely investigated IS cases.</p>
<p><strong>Methods: </strong>In a 9-year follow-up of a prospective study of 512,726 Chinese adults, 22,216 incident IS cases, confirmed by clinical adjudication of medical records, were assigned subtypes using a modified Causative Classification System for Ischemic Stroke (CCS) (large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioaortic embolism (CE), or undetermined etiology) and classified by CCS as “evident,” “probable,” or “possible” IS cases. For incompletely investigated IS cases where CCS yielded an undetermined etiology, an ML model was developed to predict IS subtypes from baseline risk factors and screening for cardioaortic sources of embolism. The 5-year risks of subsequent stroke and all-cause mortality (measured using cumulative incidence functions and 1 minus Kaplan–Meier estimates, respectively) for the ML-predicted IS subtypes were compared with etiologically classified IS subtypes.</p>
<p><strong>Results: </strong>Among 7443 IS subtypes with evident or probable etiology, 66% had SAO, 32% had LAA, and 2% had CE, but proportions of SAO-to-LAA cases varied by regions in China. CE had the highest rates of subsequent stroke and mortality (43.5% and 40.7%), followed by LAA (43.2% and 17.4%) and SAO (38.1% and 11.1%), respectively. ML provided classifications for cases with undetermined etiology and incomplete clinical data (24% of all IS cases; n = 5276), with area under the curves (AUC) of 0.99 (0.99–1.00) for CE, 0.67 (0.64–0.70) for LAA, and 0.70 (0.67–0.73) for SAO for unseen cases. ML-predicted IS subtypes yielded comparable subsequent stroke and all-cause mortality rates to the etiologically classified IS subtypes.</p>
<p><strong>Conclusion: </strong>This study highlighted substantial heterogeneity in prognosis of IS subtypes and utility of ML approaches for classification of IS cases with incomplete clinical investigations.</p> |
| first_indexed | 2024-03-07T07:59:50Z |
| format | Journal article |
| id | oxford-uuid:fab7c4f5-3caf-4b2c-b250-8adec21b64ce |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:59:50Z |
| publishDate | 2023 |
| publisher | SAGE Publications |
| record_format | dspace |
| spelling | oxford-uuid:fab7c4f5-3caf-4b2c-b250-8adec21b64ce2023-09-15T06:45:02ZHeterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adultsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:fab7c4f5-3caf-4b2c-b250-8adec21b64ceEnglishSymplectic ElementsSAGE Publications2023Chun, MQin, HTurnbull, ISansome, SGilbert, SHacker, AWright, NZhu, TClifton, DBennett, DGuo, YPei, PLv, JYu, CYang, LLi, LLu, YChen, ZCairns, BJChen, YClarke, RChina Kadoorie Biobank Collaborative Group<p><strong>Background: </strong>Reliable classification of ischemic stroke (IS) etiological subtypes is required in research and clinical practice, but the predictive properties of these subtypes in population studies with incomplete investigations are poorly understood.</p> <p><strong>Aims: </strong>To compare the prognosis of etiologically classified IS subtypes and use machine learning (ML) to classify incompletely investigated IS cases.</p> <p><strong>Methods: </strong>In a 9-year follow-up of a prospective study of 512,726 Chinese adults, 22,216 incident IS cases, confirmed by clinical adjudication of medical records, were assigned subtypes using a modified Causative Classification System for Ischemic Stroke (CCS) (large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioaortic embolism (CE), or undetermined etiology) and classified by CCS as “evident,” “probable,” or “possible” IS cases. For incompletely investigated IS cases where CCS yielded an undetermined etiology, an ML model was developed to predict IS subtypes from baseline risk factors and screening for cardioaortic sources of embolism. The 5-year risks of subsequent stroke and all-cause mortality (measured using cumulative incidence functions and 1 minus Kaplan–Meier estimates, respectively) for the ML-predicted IS subtypes were compared with etiologically classified IS subtypes.</p> <p><strong>Results: </strong>Among 7443 IS subtypes with evident or probable etiology, 66% had SAO, 32% had LAA, and 2% had CE, but proportions of SAO-to-LAA cases varied by regions in China. CE had the highest rates of subsequent stroke and mortality (43.5% and 40.7%), followed by LAA (43.2% and 17.4%) and SAO (38.1% and 11.1%), respectively. ML provided classifications for cases with undetermined etiology and incomplete clinical data (24% of all IS cases; n = 5276), with area under the curves (AUC) of 0.99 (0.99–1.00) for CE, 0.67 (0.64–0.70) for LAA, and 0.70 (0.67–0.73) for SAO for unseen cases. ML-predicted IS subtypes yielded comparable subsequent stroke and all-cause mortality rates to the etiologically classified IS subtypes.</p> <p><strong>Conclusion: </strong>This study highlighted substantial heterogeneity in prognosis of IS subtypes and utility of ML approaches for classification of IS cases with incomplete clinical investigations.</p> |
| spellingShingle | Chun, M Qin, H Turnbull, I Sansome, S Gilbert, S Hacker, A Wright, N Zhu, T Clifton, D Bennett, D Guo, Y Pei, P Lv, J Yu, C Yang, L Li, L Lu, Y Chen, Z Cairns, BJ Chen, Y Clarke, R Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults |
| title | Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults |
| title_full | Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults |
| title_fullStr | Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults |
| title_full_unstemmed | Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults |
| title_short | Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults |
| title_sort | heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes 9 year follow up of 22 000 cases in chinese adults |
| work_keys_str_mv | AT chunm heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT qinh heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT turnbulli heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT sansomes heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT gilberts heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT hackera heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT wrightn heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT zhut heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT cliftond heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT bennettd heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT guoy heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT peip heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT lvj heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT yuc heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT yangl heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT lil heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT luy heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT chenz heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT cairnsbj heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT cheny heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults AT clarker heterogeneityinthediagnosisandprognosisofischemicstrokesubtypes9yearfollowupof22000casesinchineseadults |