Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
J Investig Med. 2019 Aug;67(6):957-963. doi: 10.1136/jim-2018-000883. Epub 2019 Feb 6.
The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.
本研究旨在建立一种新的预测模型，以预测急性缺血性脑卒中（AIS）患者 1 年预后不良（死亡或改良 Rankin 量表评分≥3），并比较新预测模型与其他预测量表的性能。收集了 772 例 AIS 患者的基线数据，进行单因素和多因素逻辑回归分析，以确定 AIS 患者 1 年预后不良的独立危险因素。比较新预测模型和 THRIVE、iScore 和 ASTRAL 评分的受试者工作特征曲线（ROC）下面积（AUC）值。采用 Hosmer-Lemeshow 检验评估模型拟合优度。我们在 1 年随访时确定了 196 例（25.4%）预后不良的患者，其中 68 例（68/196，34.7%）死亡。多因素逻辑回归和 ROC 分析显示，年龄≥70 岁、意识状态（昏睡或昏迷）、既往卒中或短暂性脑缺血发作、恶性肿瘤、空腹血糖水平异常≥7.0mmol/L、美国国立卫生研究院卒中量表评分是 AIS 患者 1 年预后不良的独立危险因素。通过将β系数四舍五入为整数评分来为每个变量分配评分，建立了一个总分最高为 9 分的新预测模型。新预测模型的 AUC 值高于 THRIVE 评分（p<0.05）。Hosmer-Lemeshow 检验的χ值为 7.337（p>0.05），表明预测模型拟合良好。新预测模型可准确预测中国 AIS 患者 1 年预后不良。
