Association Between LACE+ Index Risk Category and 90-Day Mortality After Stroke

Background and objectives: A higher LACE+ index risk category (defined as LACE+ score >= 78) typically calculated before hospital discharge has been associated with increased risk of unplanned 30-day hospital readmissions and early death after hospital discharge. However, its utility to predict poststroke mortality is unknown. Here, we examined whether the LACE+ index risk category assessed at both discharge (dLACE+) and admission (aLACE+) was associated with 90-day mortality after stroke. Methods: We retrospectively analyzed 2,729 consecutive patients who presented with ischemic or hemorrhagic strokes, included in an institutional stroke registry between January 2018 and December 2021. The primary outcome of interest was 90-day mortality after the index hospitalization. Patients were categorized as high-risk (>= 78), medium-to-high-risk (59-77), and low-to-medium-risk (0-58) according to the LACE+ as automatically calculated at admission and discharge. Analyses were performed on the entire cohort, as well as stratified according to acute ischemic stroke and hemorrhagic stroke diagnosis. Results: Among patients who completed 90-day follow-up, the mortality rate was 24.3% (576/2368). In the Kaplan-Meier analysis, the high-risk aLACE+ group had the highest 90-day mortality rate as compared with low-to-medium-risk and medium-to-high-risk groups (p < 0.001). In a fully adjusted multivariable Cox-regression, the 90-day hazards of death were significantly greater among participants in a high-risk aLACE+ (aHR 1.7, 95% CI 1.080-2.742, p = 0.022) and medium-to-high-risk aLACE+ categories (aHR 1.4, 95% CI 1.141-1.778, p = 0.002) as compared with participants in the low-to-medium-risk aLACE+ category. Results were overall similar for dLACE+. Discussion: The LACE+ calculated at both admission and discharge admission identified patients with stroke at increased risk for 90-day mortality. Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death.