Baseline Stroke Severity as a Predictor of 30-Day Post-Ischemic Stroke Disability Outcome


  • Diana Teresa Fakultas Kedokteran Universitas Kristen Duta Wacana
  • Rizaldy Taslim Pinzon Fakultas Kedokteran Universitas Kristen Duta Wacana Yogyakarta
  • Sugianto Adisaputro Fakultas Kedokteran Universitas Kristen Duta Wacana Yogyakarta



Disability, National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Ischemic stroke


More than 50% of patients who survived stroke have a chronic disability. The National Institute of Health Stroke Scale (NIHSS) is a scoring system to determine the neurologic deficit of a stroke patient. This study analyzed stroke severity based on baseline NIHSS score as a determinant for 30-day post-ischemic stroke disability. This study method uses a retrospective cohort design based on medical records and stroke registry of ischemic stroke patients in Bethesda Hospital Yogyakarta. During admission, the predictive factors for the disability of the study subjects were evaluated. The baseline NIHSS assessment score was measured at 1x24 hours after admission. Disability was measured using a simplified modified Rankin Scale questionnaire (smRSq) Indonesian version at 30-day post-ischemic stroke. Statistical analysis includes univariate, bivariate, and logistic regression multivariate data analysis. The subjects were 84 patients with ischemic stroke. Disability at 30-day post-ischemic stroke occurred in 22 patients (26.2%). Logistic regression multivariate analysis show that Neutrophil to Lymphocyte Ratio (NLR) (RR: 4.488, CI: 1.873–10.756, p: 0.001) and baseline NIHSS score (RR: 28.563, CI: 2.891–282.181, p: 0.004) together significantly affect the mRS of 30-day post-ischemic stroke. Patients admitted with a higher baseline NIHSS score have a 28.5 fold risk for a worse functional outcome than those with lower baseline NIHSS scores. Stroke severity based on baseline NIHSS score is a determinant factor for disability in patients at 30-day post-ischemic stroke.


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World Health Organization. World Health Statistics 2020 Monitoring Health For The SDGs. Geneva: WHO; 2020.

Kongsawasdi S, Klaphajone J, Wivatvongvana P, and Watcharasaksilp K. Prognostic Factors of Functional Outcome Assessed by Using the Modified Rankin Scale in Subacute Ischemic Stroke. Journal of Clinical Medicine research. 2019; 11(5): 375–382.

Jiang X, Morgenstern LB, Cigolle CT, Claflin ES, and Lisabeth LD. Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2020; 54(3): 205–213.

Pinzon RT, Sanyasi RDLR. Complications as Important Predictors of Disability in Ischemic Stroke. Universa Medicina. 2017; 36(3): 197-204.

Wijayanti IG, Pinzon RT, and Pramudita EA. Faktor Prediktor Luaran Disabilitas pada Pasien Stroke Iskemik di Rumah Sakit Bethesda Yogyakarta. Neurona. 2018; 36(4): 310–315.

Lyden P. Using the National Institutes of Health Stroke Scale. Stroke. 2017; 48(2): 513–519.

Abdul-Rahim AH, Fulton RL, Sucharew H, et al. National Institutes of Health Stroke Scale Item Profiles as a Predictor of Patient Outcome: External Validation on Independent Trial Data. Stroke. 2015; 46(2): 395–400.

Khatri P, Conaway MR, and Johnston KC. Ninety-Day Outcome Rates of a Prospective Cohort of Consecutive Patients With Mild Ischemic Stroke. Stroke. 2012; 43(2): 560-562.

Rost NS, Bottle A, Lee JM, et al. Stroke Severity is a Crucial Predictor of Outcome: An International Prospective Validation Study. Journal of American Heart Association. 2016; 5(1): 1–7.

Shrestha S, Poudel RS, Khatiwada D, and Thapa L. Stroke Subtype, Age, and Baseline NIHSS Score Predict Ischemic Stroke Outcomes at 3 Months: A Preliminary Study from Central Nepal. Journal of Multidisciplinary Healthcare. 2015; 8: 443–448.

Reznik ME, Yaghi S, Jayaraman M V, et al. Baseline NIH Stroke Scale is an Inferior Predictor of Functional Outcome in the Era of Acute Stroke Intervention. International Journal of Stroke. 2018; 13(8): 806–810.

Yoshimura S, Lindley RI, Carcel C, et al. NIHSS Cut Point For Predicting Outcome In Supra- Vs Infratentorial Acute Ischemic Stroke. Neurology. 2018; 91(18): 1695–1701.

Broderick JP, Adeoye O, and Elm J. Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials. Stroke. 2017; 48(7): 2007–2012.

Bruno A, Shah N, Lin C, et al. Improving Modified Rankin Scale Assessment with a Simplified Questionnaire. Stroke. 2010; 41(5): 1048–1050.

Béjot Y, Duloquin G, Graber M, Garnier L, Mohr S, and Giroud M. Current Characteristics and Early Functional Outcome Of Older Stroke Patients: A Population-Based Study (Dijon Stroke Registry). Age Ageing. 2021; 50(5): 898-905.

Patrama AP, Tresno T, and Purwanza SW. Development of the National Institutes of Health Stroke Scale (NIHSS) for Predicting Disability and Functional Outcome to Support Discharge Planning after Ischemic Stroke. Jurnal Ners. 2019; 14(3): 413-417.

Al Qawasmeh M, Aldabbour B, Momani A, et al. Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke. Stroke Research and Treatment. 2020; 2020: 1-9.

Wouters A, Nysten C, Thijs V, and Lemmens R. Prediction of Outcome in Patients with Acute Ischemic Stroke Based on Initial Severity and Improvement in the First 24 H. Frontiers in Neurology. 2018; 9: 1–6.

Yaghi S, Herber C, Boehme AK, et al. The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke. Journal of Neuroimaging. 2017; 27(4): 388–391.

Yu AYX, Hill MD, and Coutts SB. Should Minor Stroke Patients be Thrombolyzed? A Focused Review and Future Directions. International Journal of Stroke. 2015; 10(3): 292–297.

Song SY, Zhao XX, Rajah G, et al. Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients with Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis. Frontiers in Neurology. 2019; 10: 1-16.

Harris S, Sungkar S, Rasyid A, Kurniawan M, Mesiano T, and Hidayat R. TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia. Stroke Research and Treatment. 2018; 2018: 1-6.

Elsheikh WM, Alahmar IE, Salem GM, and Matar ES. New Stroke Prognostic Factors. The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery. 2020; 56(1): 1-9.

He L, Wang J, Wang F, Zhang L, Zhang L, and Zhao W. Increased Neutrophil-to-Lymphocyte Ratio Predicts the Development of Post-Stroke Infections in Patients with Acute Ischemic Stroke. BioMed Central Neurology. 2020; 20(1): 1–7.

Kocaturk O, Besli F, Gungoren F, Kocaturk M, Tanriverdi Z. The Relationship among Neutrophil to Lymphocyte Ratio, Stroke Territory, and 3-Month Mortality in Patients with Acute Ischemic Stroke. Neurological Sciences. 2019; 40(1): 139–146.

Samai AA and Martin-Schild S. Sex Differences in Predictors of Ischemic Stroke: Current Perspectives. Vascular Health and Risk Management. 2015; 11: 427-436.

Roy-O'Reilly M and McCullough LD. Age and Sex are Critical Factors in Ischemic Stroke Pathology. Endocrinology. 2018; 159(8): 3120–3131.

Sanyasi RDLR, Pinzon RT. Clinical Symptoms and Risk Factors Comparison of Ischemic and Hemorrhagic Stroke. Jurnal Kedokteran dan Kesehatan Indonesia. 2018; 9(1): 5–15.

Cipolla MJ, Liebeskind DS, and Chan SL. The Importance of Comorbidities in Ischemic Stroke: Impact of Hypertension on the Cerebral Circulation. Journal of Cerebral Blood Flow and Metabolism. 2018; 38(12): 2129–2149.

do Carmo JF, Morelato RL, Pinto HP, and de Oliveira ERA. Disability after Stroke: A Systematic Review. Fisioterapia em Movimento. 2015; 28(2): 407–418.



2022-03-02 — Updated on 2022-04-09




Research Article