Factors Affecting Mortality of Patients Survived from First Stroke---Is Recurrence an Only Surrogate Endpoint?
Date Issued
2009
Date
2009
Author(s)
Lai, Yi-Ching
Abstract
Background Surrogate endpoints of cerebrovascular death, including stroke recurrence and biological factors of cerebrovascular disease for long-term prognosis, were barely address and qualified.im To identify significant prognostic factors (including recurrence and biological markers) responsible for long-term prognosis of first ischemic stroke, and to evaluate where recurrence and other biological markers are good surrogate endpoints for long-term prognosis by using conventional Cox regression model and also multi-state stochastic models.ethod A total of 466 patients with first stroke that were the study population designed for a randomized controlled trial on the comparison of treatment efficacy using aspirin in reducing recurrence was used. A series of predictors for long-term prognosis of death from cerebrovascular were collected. Cox regression model with or without time-dependent covariate of recurrence was used to model the proportion of treatment effect explained (PTE) for surrogate endpoint. The multi-state stochastic model with the incorporation of regressions was used to assess the role of surrogate endpoint on recurrence, other biological factors and treatment.esult By using multivariate analysis, we identified four predictors for long-term prognosis of first ischemic stroke, including recurrence, treatment, total cholesterol, and serum glucose. By using PTE method, we found the latter 3 factors were independent factors for long-term prognosis after adjustment for recurrence. The multi-state model found recurrence is a strong surrogate endpoint for long-term prognosis of cerebrovascular death. In addition, treatment, total cholesterol and glucose were three another surrogate endpoints.onclusion Surrogate endpoints with recurrence and other factors without recurrence were qualified and identified for long-term prognosis of first ischemic stroke.eywords Cerebrovascular death, multi-state Markov model, stroke recurrence, surrogate endpoint
Subjects
cerebrovacular death
multi-state Markov model
stroke recurrence
surrogat endpoint
Type
thesis
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