用于预测中国急性卒中患者3个月不良结局的START列线图的外部验证

External Validation of START nomogram to predict 3-Month unfavorable outcome in Chinese acute stroke patients.

作者信息

Song BaiLi, Chen XiangLiang, Tang Dan, Ibrahim Mako, Liu YuKai, Nyame Linda, Jiang Teng, Wang Wei, Li Xiang, Sun Chao, Zhao Zheng, Yang Jie, Zhou JunShan, Zou JianJun

机构信息

Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China.

Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

出版信息

J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1618-1622. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.032. Epub 2019 Mar 19.

DOI:10.1016/j.jstrokecerebrovasdis.2019.02.032

PMID:30898445

Abstract

BACKGROUND

Recently, the NIHSS STroke Scale score, Age, pre-stroke mRS score, onset-to-treatment Time (START nomogram) predicts 3-month functional outcome after intravenous thrombolysis in ischemic stroke patients. However, this model has not yet been an external validation. We aim to validate the performance of START nomogram.

METHODS

Data were derived from the stroke center of the Nanjing First Hospital (China). Patients who lacked the necessary data to calculate the nomogram and missed 3-month modified Ranking scale scores were excluded. Modified Rankin Scale score more than 2 at 3-month was assessed as an unfavorable outcome. We used areas under the receiver operator characteristic curves (AUC-ROC) to quantify the prognostic value. Calibration was assessed by calibration plots and Hosmer-Lemeshow (HL) goodness of fit test.

RESULT

The final cohort included 306 eligible patients. For 3-month unfavorable outcome, the AUC-ROC of the START nomogram was .766 (95%CI: .7013-.8304, P < .0001), suggesting good discrimination in the START nomogram. It also showed good calibration (HL goodness of fit test P = .1261) in the external validation sample.

CONCLUSION

The START nomogram with good predictive performance is a reliable and simple clinical instrument to predict unfavorable outcome after acute stroke.

摘要

背景

最近，美国国立卫生研究院卒中量表（NIHSS）评分、年龄、卒中前改良Rankin量表（mRS）评分、发病至治疗时间（START列线图）可预测缺血性卒中患者静脉溶栓治疗后3个月的功能结局。然而，该模型尚未进行外部验证。我们旨在验证START列线图的性能。

方法

数据来源于南京医科大学第一附属医院卒中中心（中国）。排除缺乏计算列线图所需必要数据以及未获得3个月改良Rankin量表评分的患者。将3个月时改良Rankin量表评分大于2分评估为不良结局。我们使用受试者工作特征曲线下面积（AUC-ROC）来量化预后价值。通过校准图和Hosmer-Lemeshow（HL）拟合优度检验评估校准情况。