Derivation and Internal Validation of the GLaSSES Score for Predicting Neurological Deterioration after Acute Ischemic Stroke: A Retrospective Cohort Study

A BSTRACT Background and Purpose: Neurological deterioration (ND) occurs in 5%–40% of patients with acute ischaemic stroke (AIS) during the 1 st week and is associated with worse outcomes and increased mortality. We aimed to develop and internally validate a simple bedside score for predicting ND in AIS patients not receiving reperfusion therapy. Methods: We conducted a retrospective cohort study including adults hospitalised with AIS between May 2021 and December 2023. ND within 7 days was recorded. A multivariable logistic regression model was developed using stepwise selection based on the Akaike Information Criterion. Internal validation was performed with 1000 bootstrap resamples. Calibration was assessed using the Hosmer–Lemeshow test and calibration plots. The optimal cut-off was determined using the Youden index. Results: A total of 444 patients were included, and 90 (20.3%) developed ND. Five independent predictors were identified: admission hyperglycaemia, leucocytosis, National Institutes of Health Stroke Scale severity, symptomatic intracranial stenosis and symptomatic extracranial stenosis. The derived GLaSSES score showed good discrimination and calibration. The Hosmer–Lemeshow test showed no significant lack of fit ( P = 0.1008). A cut-off of 17.5 points yielded a sensitivity of 75.6%, specificity of 90.1%, positive predictive value of 66.0% and negative predictive value of 93.5%. Mortality was higher among patients with ND (47.8%). Conclusions: The GLaSSES score is a simple bedside tool for predicting ND after AIS. External validation is required before clinical implementation.