Predicting 10-year stroke mortality: development and validation of a nomogram

Weronika A. Szlachetka, Tiberiu Pana, Mamas A Mamas, Joao H Bettencourt-Silva, Anthony K Metcalf, John F Potter, David J McLernon, Phyo Kyaw Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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Background: Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score.Methods: In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between 8 January 2003-December 2016 were followed-up for a median (interquartile range) of 5.47 (2.96-9.15) years. A Cox proportional-hazards model was used to predict 10-year post admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cellcount and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created in order to facilitate application of the score at the point of care.Results: Mean age (SD) was 78.5±10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals ) (2.87, 2.62-3.14), eGFR <15 (1.97, 1.55-2.52), 1-year increment in age (1.04, 1.04-1.05), liver disease (1.50, 1.20-1.87), peripheral vascular disease (1.39, 1.23-1.57), cancers (1.37, 1.27-1.47), heart failure (1.24, 1.15-1.34), 1-point increment in pre-stroke mRS (1.20, 1.17-1.22), atrial fibrillation (1.17, 1.10-1.24), coronary heart disease (1.09, 1.02-1.16), chronic obstructive pulmonary disease (1.13, 1.03-4 1.25) and hypertension (0.77, 0.72-0.82). Upon internal validation, the optimism-adjusted c- statistic was 0.76 and calibration slope was 0.98.Conclusions: Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.
Original languageEnglish
Pages (from-to)685–693
Number of pages9
JournalActa Neurologica Belgica
Early online date18 Aug 2021
Publication statusPublished - 1 Jun 2022

Bibliographical note

We thank the data team of the Norfolk and Norwich University Hospital Stroke Services. We also thank Professor Kristian Bowles (one of the former co-Principal Investigators of the stroke register and current Chief of Research & Innovation, Norfolk and Norwich University Hospital) and our lay steering committee members.
Conflict of Interest and Sources of Funding Statement: There are no conflicts of interest. WAS received the Medical Research Scotland 2019 Vacation Scholarship [grant number VAC-1424-2019] to perform the research. The NNUH Stroke Register is maintained by the NNUH Stroke Services.


  • ischaemic stroke
  • long-term mortality
  • prediction score
  • prognosis
  • cerebrovascular disease


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