Li Yi, Zheng Shuai, Zhang Jinghan, Wang Fumin, Liu Xinyao, He Wen
Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 May;9(10):863. doi: 10.21037/atm-20-8205.
To develop an ultrasound-derived stroke risk (USR) score combining plaque stiffness, surface morphology and lumen narrowing to evaluate the risk of stroke in patients with asymptotic carotid stenosis.
We developed the USR score in a prospective study of symptomatic and asymptomatic patients with ipsilateral carotid lumen narrowing. Multivariable analysis was performed to identify parameters associated with ischemic events, and a USR score was constructed based on the observed β coefficient. The discrimination performance of the USR score was assessed using receiver operating characteristic (ROC) curves. Twenty iterations of 5-fold cross-validation were used for internal validation.
We derived the USR score (range, 0-7) by incorporating plaque stiffness (≥80 kPa, 0 points; 60-79 kPa, 1 point; 40-59 kPa, 2 points; <40 kPa, 3 points), plaque surface (smooth, 0 points; irregular, 1 point; ulcer, 2 points) and carotid stenosis (<50%, 0 points; 50-69%, 1 point; ≥70%, 2 points). After adjusting for age and sex, the odds ratio (OR) for every 1-point increase in the USR score increase was 3.3 (P<0.001). The risk of ischemic events increased with increasing USR score (P for trend <0.001). The C statistic of the USR score was 0.84 in the derivation sample and 0.82 in the validation sample.
The USR score to assess the risk of ischemic events in patients with carotid stenosis showed preferable discrimination ability and robustness. While external validation is warranted to prove the predictive value, this risk score could help accelerate triage decisions in similar patient populations.
开发一种超声衍生的卒中风险（USR）评分，结合斑块硬度、表面形态和管腔狭窄情况，以评估无症状性颈动脉狭窄患者的卒中风险。
我们在一项对有症状和无症状的同侧颈动脉管腔狭窄患者的前瞻性研究中开发了USR评分。进行多变量分析以确定与缺血性事件相关的参数，并根据观察到的β系数构建USR评分。使用受试者操作特征（ROC）曲线评估USR评分的鉴别性能。采用20次5折交叉验证进行内部验证。
我们通过纳入斑块硬度（≥80 kPa，0分；60 - 79 kPa，1分；40 - 59 kPa，2分；<40 kPa，3分）、斑块表面（光滑，0分；不规则，1分；溃疡，2分）和颈动脉狭窄（<50%，0分；50 - 69%，1分；≥70%，2分）得出USR评分（范围0 - 7）。在调整年龄和性别后，USR评分每增加1分，比值比（OR）增加3.3（P<0.001）。缺血性事件的风险随着USR评分的增加而增加（趋势P<0.001）。在推导样本中，USR评分的C统计量为0.84，在验证样本中为0.82。
用于评估颈动脉狭窄患者缺血性事件风险的USR评分显示出较好的鉴别能力和稳健性。虽然需要外部验证来证明其预测价值，但该风险评分有助于加速对类似患者群体的分诊决策。
