THRIVE Score Accurately Predicts Ischemic Stroke Treatment Outcomes

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These predictions are all valuable in determining individual treatment as well as patient selection for clinical trials.
These predictions are all valuable in determining individual treatment as well as patient selection for clinical trials.

Total Health Risks in Vascular Events (THRIVE) score is an easy and practical tool for predicting stroke outcomes in clinical practice, according to results of a study published in the European Journal of Neurology.1 The application of THRIVE scoring not only predicted both good and poor outcomes in stroke patients following either intravenous thrombolysis (IVT) or endovascular therapy (ET) with great accuracy, but also the degree of ischemia following these treatments. These predictions are all extremely valuable in determining individual treatment, as well as patient selection for clinical trials.

The THRIVE score is a validated tool that uses 10 levels of clinical factors readily recognizable in the clinical practice setting, including age, stroke severity (measured by admission National Institute of Health Stroke Scale [NIHSS]), and the presence of 7 chronic health variables (hypertension, atrial fibrillation, diabetes mellitus, coronary artery disease, congestive heart failure, current tobacco use, and cholesterol levels).2

 

In the current study, investigators from multiple departments of the European Medical School in Oldenburg, Germany, evaluated a total of 1038 patients with anterior circulation large vessel occlusions treated between January 2008 and October 2016 with either IVT (n=546) or ET (n=492). 

The general trend in all groups was that clinical outcomes (measured by modified Rankin scale scores [mRS] at discharge) and radiological outcomes were inversely related to THRIVE scores: increasing scores strongly predicted both lower probability of a good outcome (mRS 0-2; P <.001 Mantel-Haenszel chi-squared test for trend) and a higher probability of a poor outcome (mRS 5-6; P <.001 Mantel-Haenszel chi-squared test for trend) or in-hospital death (P <.001 Mantel-Haenszel chi-squared test for trend). 

When compared with patients with identical THRIVE scores, THRIVE-c scores (which use age and NIHSS as continuous variables) significantly improved the accuracy of predicting good and poor outcomes and in-hospital death in the IVF group. The improvement in prediction in the ET group was significant only for poor outcomes, with non-significant trends towards better prediction of THRIVE-c for in-hospital death. Both THRIVE and THRIVE-c scores showed similar accuracy in predicting good outcomes in patients who had ET.

The large sample size and homogeneity of the patient population were particular strengths of this study, which was the first to report that THRIVE scores predicted the extent of ischemia on follow-up images. There was no correlation between THRIVE scores and the incidence of symptomatic intracranial hemorrhage (SICH) in either the ET or IVF group.

In the ET group, THRIVE score robustly predicted outcomes, independent of blood vessel recanalization. The same factor could not be assessed in the IVF group, as the data was not consistently available. Other limitations to the study included nonrandomized and retrospective collection of clinical outcomes data, similar to an observational study. Markers of clinical outcomes at discharge or time of in-hospital death were used to measure early outcomes, which varied the time across the patient bases.

References

  1. Kastrup A, Brunner F, Hildebrandt H, et al. THRIVE score predicts clinical and radiological outcome after endovascular therapy or thrombolysis in patients with anterior circulation stroke in everyday clinical practice. European Journal of Neurology. 2017;24:1032-1039.
  2. Flint AC, Cullen SP, Faigeles BS, Rao VA. Predicting long-term outcome after endovascular stroke treatment: the Totaled Health Risks in Vascular Events score. Am J Neuroradiol. 2010;31:1192-1196.
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