What question did this study set out to answer?

The study aims to create a multidimensional prognostic model incorporating serum globulin to predict 1-year outcomes after ischemic stroke.

February 8, 2026Open Access

Integrating serum globulin into the ICF framework: a novel multidimensional predictive model for 1-year mRS outcomes in acute ischemic stroke

Key Points

The study aims to create a multidimensional prognostic model incorporating serum globulin to predict 1-year outcomes after ischemic stroke.
Conducted a prospective analysis with 1,356 acute ischemic stroke patients.
Collected baseline data within one week of hospital admission.
Divided patients into training (70%) and validation (30%) cohorts.
Performed multivariable logistic regression to identify independent predictors.
Evaluated model performance using AUC, calibration curves, and decision curve analysis.
Identified six independent predictors: age, occupational status, BI, serum globulin, number of stroke episodes, and NIHSS.
The model achieved an AUC of 0.90 in training and 0.85 in validation.
Calibration showed good alignment with observed outcomes, confirming the model's accuracy.
Demonstrated superior net benefit for risk assessment compared to traditional strategies.

Abstract

Abstract Background The long-term functional prognosis after ischemic stroke (IS) plays a crucial role in rehabilitation planning, yet it remains challenging to predict in clinical practice. Existing prognostic models primarily focus on short-term outcomes and lack integration of multidimensional determinants. Although elevated serum globulin levels have been associated with acute neuroinflammation and short-term disability, their prognostic significance for 1-year functional outcomes within a comprehensive biopsychosocial framework has not yet been established. To address these gaps, this study aimed to develop and validate a multidimensional prognostic model that integrates serum globulin as a key inflammatory biomarker into the International Classification of Functioning, Disability and Health (ICF) framework of the World Health Organization (WHO), with the objective of predicting 1-year functional outcome in patients with acute ischemic stroke (AIS). Methods This prospective study consecutively enrolled 1,562 AIS patients at a Grade A tertiary hospital from 2021 to 2023; after data cleaning and screening, 1,356 cases were included for analysis. Baseline data were collected within 1 week of hospital admission. The study cohort was randomly divided into a training set (70%, n = 949) for model development and a validation set (30%, n = 407) for internal validation. The primary outcome was the patients’ functional status assessed using the modified Rankin Scale (mRS), 1-year post-admission. Predictors significant ( p 0.05), and well-aligned calibration curves. DCA confirmed the model’s superior net benefit over “treat-all” and “treat-none” strategies across clinically relevant high-risk thresholds (20–80%) in both training and validation cohorts. Conclusions This study successfully integrated serum globulin into the ICF framework and constructed a prognostic model for the 1-year prognosis after AIS. It enables early identification of high-risk individuals and personalized rehabilitation strategies to improve long-term recovery.

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