Gong Li, Wang Haichao, Zhu Xiaofeng, Dong Qiong, Yu Qiuyue, Mao Bingjie, Meng Longyan, Zhao Yanxin, Liu Xueyuan
Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Department of Nursing, Huashan Hospial North, Fudan University, Shanghai, China.
Front Aging Neurosci. 2021 Apr 14;13:637363. doi: 10.3389/fnagi.2021.637363. eCollection 2021.
An easily scoring system to predict the risk of cognitive impairment after minor ischemic stroke has not been available. We aimed to develop and externally validate a nomogram for predicting the probability of post-stroke cognitive impairment (PSCI) among hospitalized population with minor stroke. Moreover, the association of Trimethylamine N-oxide (TMAO) with PSCI is also investigated. We prospectively conducted a developed cohort on collected data in stroke center from June 2017 to February 2018, as well as an external validation cohort between June 2018 and February 2019. The main outcome is cognitive impairment defined as <22 Montreal Cognition Assessment (MoCA) score points 6 - 12 months following a minor stroke onset. Based on multivariate logistic models, the nomogram model was generated. Plasma TMAO levels were assessed at admission using liquid chromatography tandem mass spectrometry. A total of 228 participants completed the follow-up data for generating the nomogram. After multivariate logistic regression, seven variables remained independent predictors of PSCI to compose the nomogram included age, female, Fazekas score, educational level, number of intracranial atherosclerotic stenosis (ICAS), HbA1c, and cortical infarction. The area under the receiver-operating characteristic (AUC-ROC) curve of model was 0.829, C index was good (0.810), and the AUC-ROC of the model applied in validation cohort was 0.812. Plasma TMAO levels were higher in patients with cognitive impairment than in them without cognitive dysfunction (median 4.56 vs. 3.22 μmol/L; ≤ 0.001). In conclusion, this scoring system is the first nomogram developed and validated in a stroke center cohort for individualized prediction of cognitive impairment after minor stroke. Higher plasma TMAO level at admission suggests a potential marker of PSCI.
此前尚无一种易于评分的系统来预测轻度缺血性中风后认知障碍的风险。我们旨在开发并外部验证一种列线图，以预测轻度中风住院患者发生中风后认知障碍（PSCI）的概率。此外，还研究了氧化三甲胺（TMAO）与PSCI的关联。我们前瞻性地收集了2017年6月至2018年2月在卒中中心的数据建立了一个开发队列，并在2018年6月至2019年2月期间建立了一个外部验证队列。主要结局是认知障碍，定义为轻度中风发作后6至12个月蒙特利尔认知评估（MoCA）得分<22分。基于多变量逻辑模型，生成了列线图模型。入院时使用液相色谱串联质谱法评估血浆TMAO水平。共有228名参与者完成了用于生成列线图的随访数据。经过多变量逻辑回归分析，七个变量仍然是PSCI的独立预测因素，组成列线图的变量包括年龄、女性、 Fazekas评分、教育水平、颅内动脉粥样硬化狭窄（ICAS）数量、糖化血红蛋白（HbA1c）和皮质梗死。模型的受试者工作特征曲线下面积（AUC-ROC）为0.829，C指数良好（0.810），该模型在验证队列中的AUC-ROC为0.812。认知障碍患者的血浆TMAO水平高于无认知功能障碍的患者（中位数4.56 vs. 3.22 μmol/L；P≤0.001）。总之，这个评分系统是首个在卒中中心队列中开发并验证的用于个体化预测轻度中风后认知障碍的列线图。入院时较高的血浆TMAO水平提示可能是PSCI的一个标志物。
