Ordinal vs dichotomous analyses of modified Rankin Scale and 5-year outcome and cost of stroke

Objective – To compare how three common representations (ordinal versus dichotomized as 0-1/2-6 or 0-2/3-6) of the modified Rankin Scale (mRS) – a commonly-used trial outcome measure – relate to long-term outcomes, and quantify trial ineligibility rates based on pre-morbid mRS. Methods – In consecutive ischaemic stroke patients in a population-based, prospective cohort study (Oxford Vascular Study; 2002-2014), we related 3-month mRS to 1-year and 5-year disability and death (logistic regressions), and health/social-care costs (generalized linear model), adjusted for age/sex, and compared goodness-of-fit values (c-statistic, Mean Absolute Error [MAE]). We also calculated the proportion of patients in whom pre-morbid mRS &gt;1 or &gt;2 would result in exclusion from trials using dichotomous analysis. Results – Among 1,607 patients, the ordinal mRS was more strongly related to 5-year mortality than both the 0-1/2-6 and 0-2/3-6 dichotomies (all p&lt;0.0001). Results were similar for 5-yea...研究目标：对比改良Rankin量表（modified Rankin Scale, mRS）的三种常见赋值方式——包括有序分类版本，以及两种二分类版本（0-1/2-6分组与0-2/3-6分组，mRS为卒中领域常用的临床试验结局评价指标）——与长期结局的关联程度，并基于发病前mRS评分量化临床试验排除率。 研究方法：本研究基于2002-2014年开展的牛津血管研究（Oxford Vascular Study）这一基于人群的前瞻性队列研究，纳入连续性缺血性卒中患者。以年龄、性别作为校正因素，采用logistic回归模型分析3个月时mRS评分与1年、5年残疾发生率及死亡率的关联，采用广义线性模型分析其与健康与社会照护成本的关联；同时比较不同赋值方式的拟合优度指标（包括C统计量、平均绝对误差（Mean Absolute Error, MAE)）。此外，通过二分类分析计算发病前mRS评分＞1或＞2时，患者被排除临床试验的比例。 研究结果：共纳入1607例患者，相较于0-1/2-6与0-2/3-6两种二分类赋值方式，有序分类mRS评分与5年死亡率的关联强度更高（所有P<0.0001）。针对5年[原文未完整收尾]...