Mao Haifeng, Wu Qianyi, Lin Peiyi, Mo Junrong, Jiang Huilin, Lin Shaopeng, Rainer Timothy H, Chen Xiaohui
Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Institute of Neuroscience and Department of Neurology, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):133-141. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.025. Epub 2018 Oct 16.
Efficient assessment of patients after ischemic stroke has important reference value for doctors to choose appropriate treatment for patients. Our study aimed to develop a new prognostic model for predicting outcomes 3 months after ischemic stroke among Chinese Population.
A prospective observational cohort study among ischemic stroke patients presenting to Emergency Department in the Second Affiliated Hospital of Guangzhou Medical University was conducted from May 2012 to June 2013. Demographic data of ischemic stroke patients, assessment of NIHSS and laboratory results were collected. Based on 3-month modified Rankin Scale (mRS) ischemic stroke patients were divided into either favorable outcome (mRS: 0-2) or unfavorable outcome groups (mRS: 3-6). The variables closely associated with prognosis of ischemic stroke were selected to develop the new prognostic model (NAAP) consisted of 4 parameters: NIHSS, age, atrial fibrillation, and prealbumin. The prognostic value of the modified prognostic model was then compared with NIHSS alone.
A total of 454 patients with suspected stroke were recruited. One hundred eighty-six patients with ischemic stroke were included in the final analysis. A new prognostic model, NAAP was developed. The area under curve (AUC) of NAAP was .861 (95%confidence interval: .803-.907), whilst the AUC of NIHSS was .783 (95%CI: .717-.840), (P = .0048). Decision curve analysis showed that NAAP had a higher net benefit for threshold probabilities of 65% for predictive risk of poor outcomes.
The modified prognostic model, NAAP may be a better prognostic tool for predicting 3-month unfavorable outcomes for ischemic stroke than NIHSS alone.
对缺血性中风患者进行有效评估，对于医生为患者选择合适的治疗方法具有重要参考价值。我们的研究旨在开发一种新的预后模型，用于预测中国人群缺血性中风后3个月的预后情况。
2012年5月至2013年6月，在广州医科大学附属第二医院急诊科对缺血性中风患者进行了一项前瞻性观察队列研究。收集缺血性中风患者的人口统计学数据、美国国立卫生研究院卒中量表（NIHSS）评估结果和实验室检查结果。根据3个月改良Rankin量表（mRS），将缺血性中风患者分为预后良好组（mRS：0 - 2）和预后不良组（mRS：3 - 6）。选择与缺血性中风预后密切相关的变量，开发由4个参数组成的新预后模型（NAAP）：NIHSS、年龄、心房颤动和前白蛋白。然后将改良预后模型的预后价值与单独使用NIHSS进行比较。
共招募了454例疑似中风患者。最终纳入分析的缺血性中风患者有186例。开发了一种新的预后模型NAAP。NAAP的曲线下面积（AUC）为0.861（95%置信区间：0.803 - 0.907），而NIHSS的AUC为0.783（95%CI：0.717 - 0.840），（P = 0.0048）。决策曲线分析表明，对于不良结局预测风险的阈值概率为65%时，NAAP具有更高的净效益。
改良的预后模型NAAP可能是一种比单独使用NIHSS更好的预后工具，用于预测缺血性中风3个月的不良结局。
