Predicting Domain-Specific Health-Related Quality of Life Using Acute Infarct Volume

Stroke. 2017 Jul;48(7):1925-1931. doi: 10.1161/STROKEAHA.117.017094. Epub 2017 May 23.


Background and purpose: Limited data exist on the relationship between acute infarct volume and health-related quality of life (HRQOL) measures after ischemic stroke. We evaluated whether acute infarct volume predicts domain-specific Neuro-Quality of Life scores at 3 months after stroke.

Methods: Between 2012 and 2014, we prospectively enrolled consecutive patients with ischemic stroke and calculated infarct volume. Outcome scores at 3 months included modified Rankin Scale and Neuro-Quality of Life T scores. We evaluated whether volume organized by quartiles predicted modified Rankin Scale and HRQOL scores at 3 months using logistic and linear regression as appropriate, adjusting for relevant covariates. We calculated variance accounted for (R2) overall and by volume for each domain of HRQOL.

Results: Among 490 patients (mean age 64.2±15.86 years; 51.2% male; 63.3% White) included for analysis, 58 (11.8%) were disabled (modified Rankin Scale score of >2) at 3 months. In unadjusted analysis, the highest volume quartile remained a significant predictor of 1 HRQOL domain, applied cognition-general concerns (R2=0.06; P<0.001). Our fully adjusted prediction model explained 32% to 51% of the variance in HRQOL: upper extremity (R2=0.32), lower extremity (R2=0.51), executive function (R2=0.45), and general concerns (R2=0.34).

Conclusions: Acute infarct volume is a poor predictor of HRQOL domains after ischemic stroke, with the exception of the cognitive domain. Overall, clinical and imaging variables explained <50% of the variance in HRQOL outcomes at 3 months. Our data imply that a broad range of factors, some known and others undiscovered, may better predict poststroke HRQOL than what is currently available.

Keywords: cognition; lower extremity; magnetic resonance imaging; patient outcome assessment; quality of life; stroke.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / physiopathology
  • Cerebral Infarction / diagnostic imaging*
  • Cerebral Infarction / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Outcome Assessment*
  • Quality of Life*
  • Severity of Illness Index
  • Stroke / diagnostic imaging*
  • Stroke / physiopathology