Comparative prognostic value of the NIHSS and Glasgow coma scale for in-hospital mortality in patients under 60 years with acute ischemic stroke
DOI:
https://doi.org/10.14748/21850h51Keywords:
Ischemic stroke; NIHSS; Glasgow Coma Scale; in-hospital mortality; young adults; prognostic factorsAbstract
Introduction: Stroke remains a leading cause of mortality and disability worldwide, with a considerable burden observed among young and middle-aged adults. Prognostic tools are essential for early risk stratification and treatment planning in this population.
Aims: The aim of this article is to compare the prognostic value of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) for predicting in-hospital mortality in patients under 60 years of age with acute ischemic stroke.
Patients and Methods: A retrospective observational study was conducted at the Second Clinic of Neurology with Intensive Care Unit (ICU) and Stroke Unit, at St. Marina University Hospital in Varna, including 168 patients aged 18–59 years, admitted between 2017 and 2022. Patients were divided into a mortality group (n = 67) and a survivor group (n = 101). Baseline neurological status was assessed using NIHSS and GCS. Statistical analyses included Mann-Whitney U test, Chi-squared test, and ROC curve analysis.
Results: Patients in the mortality group were significantly older (51.99 ± 7.20 vs. 47.52 ± 8.11 years, p < 0.001). The mean NIHSS score was higher among non-survivors (17.07 ± 7.705 vs. 7.00 ± 5.219, p < 0.001), while the mean GCS score was lower (10.01 ± 3.466 vs. 13.95 ± 1.824, p<0.001). The ROC analysis showed excellent discriminatory power for both scales: NIHSS (AUC = 0.865, 95% CI: 0.813–0.917) and GCS (AUC = 0.850). Optimal cut-offs were ≥ 10 for NIHSS and ≤ 10 for GCS, with sensitivity/specificity of 77.6%/74.3% and 86.6%/100%, respectively.
Conclusion: Both NIHSS and GCS demonstrated strong prognostic value for in-hospital mortality in young and middle-aged stroke patients. Given its simplicity and accuracy, GCS may serve as a rapid and reliable prognostic tool in clinical practice.
References
1. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(2):132–44. doi: 10.1177/17474930241308142. DOI: https://doi.org/10.1177/17474930241308142
2. Handschu R, Haslbeck M, Hartmann A, et al. Mortality prediction in critical care for acute stroke: Severity of illness-score or coma-scale? J Neurol. 2005;252(10):1249–54. doi: 10.1007/s00415-005-0853-5. DOI: https://doi.org/10.1007/s00415-005-0853-5
3. Kasner SE, Chalela JA, Luciano JM, et al. Reliability and Validity of Estimating the NIH Stroke Scale Score from Medical Records. Stroke. 1999;30(8):1534–7. doi: 10.1161/01.STR.30.8.1534. DOI: https://doi.org/10.1161/01.STR.30.8.1534
4. Nedeltchev K. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005;76(2):191–5. doi: 10.1136/jnnp.2004.040543. DOI: https://doi.org/10.1136/jnnp.2004.040543
5. Weir CJ, Bradford APJ, Lees KR. The prognostic value of the components of the Glasgow Coma Scale following acute stroke. QJM. 2003;96(1):67–74. doi: 10.1093/qjmed/hcg008. DOI: https://doi.org/10.1093/qjmed/hcg008
6. Padwale V, Chivate C, Kirnake V, et al. Comparative Prognostic Value of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) in Supratentorial and Infratentorial Stroke Patients in Western India. Cureus. 2024;16(7):e65778 doi: 10.7759/cureus.65778. DOI: https://doi.org/10.7759/cureus.65778
7. Schneider S, Vibo R, Taba N, et al. Mortality in young adult patients with acute ischaemic stroke. Acta Neurol Scand. 2020;141(3):242–9. doi: 10.1111/ane.13217. DOI: https://doi.org/10.1111/ane.13217
8. Koton S, Tanne D, Green MS, et al. Mortality and predictors of death 1 month and 3 years after first-ever ischemic stroke: data from the first national acute stroke Israeli survey (NASIS 2004). Neuroepidemiology. 2010;34(2):90–6. doi: 10.1159/000264826. DOI: https://doi.org/10.1159/000264826
9. Van Valburg MK, Sesmu Arbous M, et al. Clinical predictors of survival and functional outcome of stroke patients admitted to critical care. Crit Care Med. 2018;46(7):1085–92. doi: 10.1097/CCM.0000000000003127. DOI: https://doi.org/10.1097/CCM.0000000000003127
10. Viderman D, Issanov A, Temirov T, et al. Outcome Predictors of Stroke Mortality in the Neurocritical Care Unit. Front Neurol. 2020;11:579733. doi: 10.3389/fneur.2020.579733. DOI: https://doi.org/10.3389/fneur.2020.579733
11. Purroy F, Vena A, Forné C, et al. Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients. Cerebrovasc Dis. 2019;47(3–4):151–64. doi: 10.1159/000500205. DOI: https://doi.org/10.1159/000500205
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Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to ethical restrictions, individual patient data are not publicly available.
