Introduction: Spontaneous intracerebral hemorrhage (ICH) is one of leading causes of mortality and morbidity worldwide. Several predictive models have been developed for ICH; however, none of them have been consistently used in routine clinical practice or clinical research. In the study, we aimed to develop and validate a risk score for predicting 1-year functional outcome after ICH (ICH Functional Outcome Score, ICH-FOS). Furthermore, we compared discrimination of the ICH-FOS and 8 existing ICH scores with regard to 30-day, 3-month, 6-month, and 1-year functional outcome and mortality after ICH. Methods: The ICH-FOS was developed based on the China National Stroke Registry, in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1 year after ICH. Multivariable logistic regression was performed to determine independent predictors, and β-coefficients were used to generate scoring system of the ICH-FOS. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. Results: The overall 1-year poor functional outcome (mRS ≥ 3) was 46.7% and 44.9% in the derivation (n = 1,953) and validation (n = 1,302) cohorts, respectively. A 16-point ICH-FOS was developed from the set of independent predictors of 1-year poor functional outcome after ICH including age (P < 0.001), admission National Institutes of Health Stroke Scale score (P < 0.001), Glasgow Coma Scale score (P < 0.001), blood glucose (P = 0.002), ICH location (P < 0.001), hematoma volume (P < 0.001), and intraventricular extension (P < 0.001). The ICH-FOS showed good discrimination (AUROC) in the derivation (0.836, 95% CI: 0.819-0.854) and validation (0.830, 95% CI: 0.808-0.852) cohorts. The ICH-FOS was well calibrated (Hosmer-Lemeshow test) in the derivation (P = 0.42) and validation (P = 0.39) cohort. When compared to 8 prior ICH scores, the ICH-FOS showed significantly better discrimination with regard to 1-year functional outcome and mortality after ICH (all P < 0.0001). Meanwhile, the ICH-FOS also demonstrated either comparable or significantly better discrimination for poor functional outcome and mortality at 30-day, 3-month, and 6-month after ICH. Conclusion: The ICH-FOS is a valid clinical grading scale for 1-year functional outcome after ICH. Further validation of the ICH-FOS in different populations is needed.

Accumulating evidence has shown that cigarette smoking is an important risk factor for ischemic stroke. However, it is not clear about the potential mechanisms through which cigarette smoking affects stroke risk. In the study, we aimed to investigate the relationship between cigarette smoking and the occurrence of extracranial (ECAS) and intracranial atherosclerotic stenosis (ICAS). We analyzed patients enrolled in the Chinese intracranial atherosclerosis (CICAS), which was a prospective, multicenter, hospital-based cohort study. Smoking status was classified into never, former and current smoking. For those patients with current smoking, data on time duration (year) and extent (the number of cigarette smoked per day) was recorded and pack year of smoking was calculated. ICAS was evaluated with 3-dimentional time-of-flight MRA and ECAS was evaluated with cervical ultrasonography or contrast-enhanced MRA. Multivariable Logistic regression was performed to identify the association between smoking status and the occurrence of ECAS and ICAS. A total of 2656 patients (92.7%) of acute ischemic stroke and 208 (7.3%) of transient ischemic attack were analyzed. The mean age was 61.9 ± 11.2 and 67.8% were male. There were 141 (4.9%) patients had only ECAS, 1074 (37.5%) had only ICAS, and 261 (9.1%) had both ECAS and ICAS. Current smoking was significantly associated with the occurrence of ECAS (adjusted OR = 1.47, 95% CI = 1.09–1.99, P < 0.01). In addition, with 1 year of smoking increment, the risk of ECAS increased by 1.1% (adjusted OR = 1.011; 95% CI = 1.003–1.019; P = 0.005); with one cigarette smoked per day increment, the risk of ECAS increased by 1.0% (adjusted OR = 1.010; 95% CI = 1.001–1.020; P = 0.03); and with one pack year of smoking increment, the risk of ECAS increased by 0.7% (adjusted OR = 1.007; 95% CI = 1.002–1.012; P < 0.01). However, no significant association was found between smoking status and the occurrence of ICAS. A dose–response relationship was identified between cigarette smoking and the occurrence of ECAS, but not ICAS. Further studies on molecular mechanisms were warranted.

Gastrointestinal bleeding (GIB) is a common and often serious complication after stroke. Although several risk factors for post-stroke GIB have been identified, no reliable or validated scoring system is currently available to predict GIB after acute stroke in routine clinical practice or clinical trials. In the present study, we aimed to develop and validate a risk model (acute ischemic stroke associated gastrointestinal bleeding score, the AIS-GIB score) to predict in-hospital GIB after acute ischemic stroke.

Background: Despite accumulating evidence supporting the association between variants of the ALOX5AP gene and atherosclerotic vascular events, the precise mechanism is still unclear. No variants in the coding sequence that lead to amino acid substitution have been found. We investigated genetic variants in the promoter region of the ALOX5AP gene and the association with ischemic stroke in a north Chinese Han population. Methods: 505 cases of ischemic stroke and 500 age- and gender-matched controls of the north Chinese Han population were enrolled. Genetic variants in the promoter region of the ALOX5AP gene were identified by polymerase chain reaction and DNA sequencing. 40 cases and 40 controls were randomly selected and compared for serum leukotriene B4 (LTB4) concentration. The effect on ischemic stroke was evaluated by logistic regression. Results: Three genetic variants were identified, including a mutation (–519 G > A), an insertion and deletion polymorphisms (–581_582 Ins A) and a single nuclear polymorphisms (–946 A > G). Association study showed that the II genotype of –581_582 Ins A was significantly associated with ischemic stroke of a large artery atherosclerosis (OR = 3.50, 95% CI = 1.93–6.36, p = 0.0002) and undetermined etiology (OR = 3.66, 95% CI = 1.92–6.94, p = 0.0006). No significant association was found between the –519 GA genotype (OR = 0.35, 95% CI = 0.02–5.88, p = 0.46), –946 AG genotype (OR = 1.35, 95% CI = 0.85–2.16, p = 0.21) and ischemic stroke. There was no significant difference in serum LTB4 concentration between cases (n = 40) and controls (n = 40) (log serum LTB4 of cases vs. controls: 2.67 ± 0.14 vs. 2.73 ± 0.18 pg/ml, p = 0.10). However, the serum LTB4 concentration was significantly higher in participants with the II genotype of –581_582 Ins A (n = 12) than that of participants with the DD genotype (n = 68) (log serum LTB4 of participants with II genotype vs. DD genotype: 2.82 ± 0.18 vs. 2.68 ± 0.15 pg/ml, p = 0.01). Conclusion: The –581_582 Ins A polymorphism might be a novel genetic risk factor for ischemic stroke in a north Chinese Han population. Further studies on molecular mechanism are warranted.

Objectives: To compare the discrimination and calibration of six risk scoring systems in the assessment of patients with stroke‐associated pneumonia (SAP) after acute ischemic stroke.Methods: The validation cohort was derived from the Third China National Stroke Registry. SAP was diagnosed according to the criteria for hospital‐acquired pneumonia of the Centers for Disease Control and Prevention. The area under the receiver operating characteristic curve (AUROC) and Hosmer‐Lemeshow goodness‐of‐fit test were used to assess discrimination and calibration.Results: A total of 12,071 patients were included in the study and 606 (5.02%) patients were diagnosed with in‐hospital SAP after ischemic stroke. The AUROC of the six clinical scores ranged from 0.660 to 0.752. In the pairwise comparison, the AIS‐APS score (0.752, 95% CI = 0.730–0.773, p < 0.001) showed significantly better discrimination than the other risk models, except the PASS score. The AIS‐APS score had the largest Cox and Snell R ² for in‐hospital SAP after ischemic stroke. In the subgroup analysis, among patients over 61 years of age, all TOAST subtypes except small vessel disease, length of hospital stay longer than 8 days, male and female sex, different groups stratified by admission NIHSS score and time from onset to arrival, the AIS‐APS score showed better discrimination than other risk models with regard to SAP after AIS.Conclusions: Our study compared the discrimination and calibration of the Kwon Pneumonia Score, A2DS2 score, PANTHERIS score, AIS‐APS score, ISAN score, and PASS score in SAP identification; of these, the AIS‐APS score showed the best performance.