Deans' stroke musings: Is Post-Stroke Mortality Risk Predicted by LACE+ Scores at Admission, Discharge?

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, November 28, 2024

Is Post-Stroke Mortality Risk Predicted by LACE+ Scores at Admission, Discharge?

Instead of this prediction crapola, why aren't you providing EXACT PROTOCOLS that prevent this mortality?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

When these persons become the 1 in 4 per WHO that has a stroke : they'll want 100% recovery and by then it will be too late.

Is Post-Stroke Mortality Risk Predicted by LACE+ Scores at Admission, Discharge?

References:

Jun-O’Connell A, Silver B, Grigoriciuc E, Gulati A, Kobayashi KJ, Henninger N. Association between LACE+ index risk category and 90-day mortality after stroke. Neurol Clin Pract. 2025;15(1):e200363. doi:10.1212/CPJ.0000000000200363

LACE+ scores calculated at admission and discharge can be used to identify patients with stroke who are at a greater risk for 90-day mortality.

The LACE+ (hospital Length of stay, Admission acuity, Comorbid conditions, and Emergency department use within 6 months of admission, plus other relevant factors) calculated at both admission (aLACE+) and discharge (dLACE+) predicts mortality risk among patients with stroke, according to study findings published in Neurology Clinical Practice.

Researchers conducted a retrospective review of a prospectively accrued cohort to explore whether aLACE+ and dLACE+ indices were independently related to 90-day mortality following stroke. Adults who presented with ischemic or hemorrhagic strokes between January 2018 and December 2021 were eligible for inclusion and categorized as high (score, ≥78), medium to high (score, 59-77), or low to medium (score, 0-58) risk. The primary outcome was mortality at 90 days after the index hospitalization. Cox regression models were used in statistical analysis.

A total of 2729 patients (median age, 70; men, 51.9%) were included in the study, of whom 474 (17.3%) died in the hospital or were discharged to hospice.

Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death,

According to the Kaplan-Meier analysis, cumulative 90-day survival was higher among patients in the low to medium vs medium to high or high aLACE+ risk categories (P <.001).

A higher aLACE+ risk category was independently associated with a higher mortality risk at 90 days (adjusted hazard ratio [aHR], 1.36; 95% CI, 1.13-1.64; P =.001), according to ordinal analysis. This association was sustained after excluding patients with withdrawal of life sustaining therapies (aHR, 1.57; 95% CI, 1.03-2.40; P =.035).

Overall, participants in the high vs low to medium aLACE+ risk category had a 62.9% higher risk for death within 90 days (aHR, 1.69; 95% CI, 1.06-2.69; P =.027) in categorical analysis. Participants in the medium to high vs low to medium aLACE+ risk category also had a 58.7% higher 90-day mortality risk (aHR, 1.42; 95% CI, 1.14-1.78; P =.002).

Similarly, cumulative 90-day survival in participants without withdrawal of life sustaining therapies was higher among patients in the low to medium vs medium to high or high aLACE+ risk categories (P <.001).

A higher dLACE+ risk category was independently associated with a higher mortality risk at 90 days (aHR, 1.82; 95% CI, 1.31-2.53).

Participants in the high vs low to medium LACE+ risk category had an 80.2% higher risk for death within 90 days. Compared with low to medium, high (aHR, 6.18; 95% CI, 1.90-20.13; P =.002) and medium to high (aHR, 4.04; 95% CI, 1.27-12.88; P =.018) dLACE+ risk categories were associated with greater mortality risk.

This study was limited by its retrospective, single-center design.

“Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death,” the study authors concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.