Abstract WP556: Predicting Modified Rankin Scale Using Prior Cognition Measure: Results From CLEAR III Study

Introduction: Intraventricular hemorrhage (IVH) is a subtype of intracerebral hemorrhage (ICH) accounting for 50% mortality and serious survivor disability. We examined whether screening Mini-Mental State Examination (MMSE) scores assessed at days 30 and/or 180 could predict good functional outcome, measured by modified Rankin Scale (mRS) at days 180 and 365 post-stroke. Methodology: CLEAR III was a multicenter, randomized, phase III trial that tested the benefits of accelerated IVH clot removal. Patients were followed for one year with MMSE and mRS collected at days 30 (D30), 180 (D180) and 365 (D365). Good functional outcome was defined as mRS 0-3. Of 500 patients randomized, 354 known survivors were analyzed. Multivariate logistic regression (MLR) was used to estimate the relationship between good D180 and D365 mRS and D30 and/or D180 MMSE adjusting for age and any ICH location. Results: The model predicted a 15% increase in the odds of good D180 mRS for each unit increase in D30 MMSE (OR [95% CI] =1.15 [1.11, 1.20], p-value<0.001). Based on this model, a score of MMSE of 14 or higher is associated with good D180 mRS with 77% sensitivity, 75% specificity, and 76% correctly classified cases (AUC=0.84). In MLR model, D30 MMSE (AOR [95% CI]=1.14 [1.10, 1.19], p-value<0.001) and thalamus ICH location (AOR [95% CI]=0.18 [0.09, 0.38], p-value<0.001) were significant predictors of good D180 mRS, with no significant association with age (AOR [95% CI]=0.97 [0.94, 1.00], p-value=0.073). Similarly, we saw a 14% increase (AOR [95% CI]=1.14, [1.09, 1.20], p-value<0.001) in the odds of good D365 mRS for each unit increase in D30 MMSE, and 9% increase (AOR [95% CI]=1.09, [1.03, 1.15], p-value=0.002) in the odds of good D365 mRS for each unit increase in D180 MMSE (p-value <0.001, AUC=0.88). D30 MMSE (AOR [95% CI]=1.12 [1.06, 1.18], p-value<0.001), D180 MMSE (AOR [95% CI]=1.12 [1.05, 1.19], p-value=0.001), age (AOR [95% CI]=0.96 [0.92, 1.00], p-value=0.041), and thalamus ICH location (AOR [95% CI]=0.17 [0.07, 0.44], p-value<0.001) were significantly associated with good D365 mRS. Conclusion: Cognition measurements, such as MMSE, may be helpful in predicting good functional outcomes at D180 and D365 post-stroke.