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一项预测中国急性缺血性脑卒中机械取栓治疗患者三个月不良结局概率的 NAC 列线图。

A NAC nomogram to predict the probability of three-month unfavorable outcome in Chinese acute ischemic stroke patients treated with mechanical thrombectomy.

机构信息

School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.

Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

出版信息

Int J Neurosci. 2021 Feb;131(2):163-169. doi: 10.1080/00207454.2020.1733565. Epub 2020 Feb 26.

Abstract

BACKGROUND AND PURPOSE

Mechanical thrombectomy (MT) is a standard care for most acute ischemic stroke (AIS) patients. For AIS patients underwent MT, predicting the patients at high risk of unfavorable outcome and adjusting therapeutic strategies accordingly can greatly improve patient outcomes. We aimed to develop and validate a nomogram for individualized prediction of Chinese AIS patients underwent MT.

METHODS

We conducted a multicenter prospective study including 238 AIS patients who underwent MT from January 2014 to December 2018. The main outcome measure was three-month unfavorable outcome (modified Rankin Scale 3-6). A nomogram was generated based on multivariate logistic model. We assessed the discriminative performance by using the area under the receiver-operating characteristic curve and calibration of risk prediction model by using the Hosmer-Lemeshow test.

RESULTS

In NAC nomogram, IHSS (National Institutes of Health Stroke Scale) score on admission (OR: 1.193,  < 0.0001), ge (OR: 1.025,  = 0.037) and reatinine (OR: 1.028,  < 0.0001) remained independent predictors of 3-month unfavorable outcome in Chinese AIS patients treated with MT. The NAC nomogram exhibited an area under the curve of 0.816 for predicting functional impairment. Calibration was good ( = 0.560 for the Hosmer-Lemeshow test).

CONCLUSIONS

The NAC nomogram is the first nomogram developed and validated in Chinese AIS patients treated with MT and it may be used to predict 3 months unfavorable outcome for these patients.

摘要

背景与目的

机械取栓术(MT)是大多数急性缺血性脑卒中(AIS)患者的标准治疗方法。对于接受 MT 的 AIS 患者,预测其预后不良风险高的患者,并相应地调整治疗策略,可以极大地改善患者的预后。我们旨在开发和验证一种用于预测接受 MT 的中国 AIS 患者的个体化预测的列线图。

方法

我们进行了一项多中心前瞻性研究,纳入了 2014 年 1 月至 2018 年 12 月期间接受 MT 的 238 例 AIS 患者。主要结局指标是三个月时的不良结局(改良 Rankin 量表 3-6 分)。基于多变量逻辑回归模型生成列线图。我们使用接受者操作特征曲线下面积来评估判别性能,并使用 Hosmer-Lemeshow 检验来评估风险预测模型的校准。

结果

在 NAC 列线图中,入院时 NIHSS 评分(OR:1.193, < 0.0001)、性别(OR:1.025, = 0.037)和肌酐(OR:1.028, < 0.0001)仍然是接受 MT 的中国 AIS 患者 3 个月不良结局的独立预测因素。NAC 列线图预测功能障碍的曲线下面积为 0.816。校准良好(Hosmer-Lemeshow 检验 = 0.560)。

结论

NAC 列线图是第一个在中国接受 MT 治疗的 AIS 患者中开发和验证的列线图,它可以用于预测这些患者的 3 个月不良结局。

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