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Fast L, Temuulen U, Villringer K, Kufner A, Ali HF, Siebert E, Huo S, Piper SK, Sperber PS, Liman T, Endres M, Ritter K. Machine learning-based prediction of clinical outcomes after first-ever ischemic stroke. Front Neurol 2023; 14:1114360. [PMID: 36895902 PMCID: PMC9990416 DOI: 10.3389/fneur.2023.1114360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Background Accurate prediction of clinical outcomes in individual patients following acute stroke is vital for healthcare providers to optimize treatment strategies and plan further patient care. Here, we use advanced machine learning (ML) techniques to systematically compare the prediction of functional recovery, cognitive function, depression, and mortality of first-ever ischemic stroke patients and to identify the leading prognostic factors. Methods We predicted clinical outcomes for 307 patients (151 females, 156 males; 68 ± 14 years) from the PROSpective Cohort with Incident Stroke Berlin study using 43 baseline features. Outcomes included modified Rankin Scale (mRS), Barthel Index (BI), Mini-Mental State Examination (MMSE), Modified Telephone Interview for Cognitive Status (TICS-M), Center for Epidemiologic Studies Depression Scale (CES-D) and survival. The ML models included a Support Vector Machine with a linear kernel and a radial basis function kernel as well as a Gradient Boosting Classifier based on repeated 5-fold nested cross-validation. The leading prognostic features were identified using Shapley additive explanations. Results The ML models achieved significant prediction performance for mRS at patient discharge and after 1 year, BI and MMSE at patient discharge, TICS-M after 1 and 3 years and CES-D after 1 year. Additionally, we showed that National Institutes of Health Stroke Scale (NIHSS) was the top predictor for most functional recovery outcomes as well as education for cognitive function and depression. Conclusion Our machine learning analysis successfully demonstrated the ability to predict clinical outcomes after first-ever ischemic stroke and identified the leading prognostic factors that contribute to this prediction.
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Affiliation(s)
- Lea Fast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Uchralt Temuulen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Kersten Villringer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Anna Kufner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Huma Fatima Ali
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eberhard Siebert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuroradiology, Berlin, Germany
| | - Shufan Huo
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany
| | - Sophie K Piper
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Pia Sophie Sperber
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, NeuroCure Clinical Research Center (NCRC), Berlin, Germany.,Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Thomas Liman
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen, DZNE), Partner Site Berlin, Berlin, Germany.,Department of Neurology, Evangelical Hospital Oldenburg, Carl von Ossietzky-University, Oldenburg, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, NeuroCure Clinical Research Center (NCRC), Berlin, Germany.,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen, DZNE), Partner Site Berlin, Berlin, Germany
| | - Kerstin Ritter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Bernstein Center for Computational Neuroscience (BCCN), Berlin, Germany
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Huo S, Kränkel N, Nave AH, Sperber PS, Rohmann JL, Piper SK, Heuschmann PU, Landmesser U, Endres M, Siegerink B, Liman TG. Endothelial and Leukocyte-Derived Microvesicles and Cardiovascular Risk After Stroke: PROSCIS-B. Neurology 2020; 96:e937-e946. [PMID: 33184230 DOI: 10.1212/wnl.0000000000011223] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/05/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the role of circulating microvesicles (MV) on long-term cardiovascular outcomes after stroke, we measured them in patients with first-ever stroke with a 3-year follow-up. METHODS In the Prospective Cohort With Incident Stroke Berlin (PROSCIS-B), patients with first-ever ischemic stroke were followed up for 3 years. The primary combined endpoint consisted of recurrent stroke, myocardial infarction, and all-cause mortality. Citrate-blood levels of endothelial MV (EMV), leukocyte-derived MV (LMV), monocytic MV (MMV), and platelet-derived MV (PMV) were measured with flow cytometry. Kaplan-Meier curves and adjusted Cox proportional hazards models were used to estimate the effect of MV levels on the combined endpoint. RESULTS Five hundred seventy-one patients were recruited (median age 69 years, 39% female, median NIH Stroke Scale score 2, interquartile range 1-4), and 95 endpoints occurred. Patients with levels of EMV (adjusted hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.2-4.9) or LMV (HR 3.1, 95% CI 1.4-6.8) in the highest quartile were more likely to experience an event than participants with lower levels with the lowest quartile used as the reference category. The association was less pronounced for PMV (HR 1.7, 95% CI 0.9-3.2) and absent for MMV (HR 1.1, 95% CI 0.6-1.8). CONCLUSION High levels of EMV and LMV after stroke were associated with worse cardiovascular outcome within 3 years. These results reinforce that endothelial dysfunction and vascular inflammation affect the long-term prognosis after stroke. EMV and LMV might play a role in risk prediction for stroke patients. CLINICALTRIALSGOV IDENTIFIER NCT01363856. CLASSIFICATION OF EVIDENCE This study provides Class II evidence of the effect of MV levels on subsequent stroke, myocardial infarction, or all-cause mortality in survivors of mild stroke.
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Affiliation(s)
- Shufan Huo
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany.
| | - Nicolle Kränkel
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Alexander Heinrich Nave
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Pia Sophie Sperber
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Jessica Lee Rohmann
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Sophie Käthe Piper
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Peter Ulrich Heuschmann
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Ulf Landmesser
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Matthias Endres
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Bob Siegerink
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
| | - Thomas Günter Liman
- From the Center for Stroke Research Berlin CSB (S.H., A.H.N., P.S.S., J.L.R., M.E., B.S., T.G.L.), Klinik für Neurologie (S.H., A.H.N., M.E., T.G.L.), Institute of Public Health (J.L.R.), Institute of Biometry and Clinical Epidemiology (S.K.P.), Campus Benjamin Franklin (N.K., U.L.), Department of Cardiology, and Excellence Cluster Neurocure (M.E.), Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin (S.H., N.K., A.H.N., P.S.S., U.L., M.E., T.G.L.); Berlin Institute of Health (A.H.N., S.K.P.); Institute of Clinical Epidemiology and Biometry (P.H.), University of Würzburg; Clinical Trial Center Würzburg (P.H., U.L.), University Hospital Würzburg; and DZNE (German Center for Neurodegenerative Disease) Partner Site Berlin (M.E.), Germany
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