Ji Ruijun, Liu Yanfang, Liu Xinyu, Wang Linlin, Wang Dandan, Wang Wenjuan, Zhang Runhua, Jiang Ruixuan, Jia Jiaokun, Feng Hao, Ding Zeyu, Liu Gaifen, Lu Jingjing, Ju Yi, Zhao Xingquan
Department of Neurology, Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Ann Transl Med. 2022 Apr;10(7):397. doi: 10.21037/atm-21-4046.
This study aimed to systematically compare the discrimination and calibration of 5 clinical scores for stroke-associated pneumonia (SAP) after intracerebral hemorrhage (ICH).
We derived a validation cohort from the Beijing Registration of Intracerebral Hemorrhage. SAP was then diagnosed according to the Center for Disease Control and Prevention's criteria for hospital-acquired pneumonia. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration.
A total of 1964 patients were enrolled in the study. The mean age was 56.8±14.4 years, and 67.6% were male. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 11 [interquartile range (IQR), 3-21], while the median length of stay (LOS) was 16 days (IQR, 8-22 days). A total of 575 (29.2%) patients were diagnosed with in-hospital SAP after ICH. The AUROC of the 5 clinical scores ranged from 0.732 to 0.800. In comparing these scores, we found that the ICH-associated pneumonia score-B (ICH-APS-B 0.800; 95% CI: 0.780-0.820; P<0.001) showed a statistically better discrimination than did the other risk models (all P<0.001). Furthermore, all clinical scores performed better in patients with an LOS >72 h. The ICH-APS-B (0.827; 95% CI: 0.806-0.848; P<0.001) still showed statistically better discrimination than did the other risk models in patients with an LOS longer than 72 hours. The Hosmer-Lemeshow test also revealed that the ICH-APS-B. had the largest Cox and Snell R2 result for in-hospital SAP after ICH.
Among the 5 models for predicting SAP after ICH, the ICH-APS-B showed the best predictive performance, suggests it may be a useful tool for implementing the personalized care of patients and conducting clinical trials of SAP after ICH.
本研究旨在系统比较5种脑出血（ICH）后卒中相关性肺炎（SAP）临床评分的辨别能力和校准度。
我们从北京脑出血登记处获取了一个验证队列。然后根据美国疾病控制与预防中心的医院获得性肺炎标准诊断SAP。采用受试者操作特征曲线下面积（AUROC）和Hosmer-Lemeshow拟合优度检验来评估模型的辨别能力和校准度。
本研究共纳入1964例患者。平均年龄为56.8±14.4岁，男性占67.6%。入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数为11[四分位间距（IQR），3 - 21]，而住院时间（LOS）中位数为16天（IQR，8 - 22天）。共有575例（29.2%）患者在ICH后被诊断为院内SAP。5种临床评分的AUROC范围为0.732至0.800。在比较这些评分时，我们发现脑出血相关性肺炎评分-B（ICH-APS-B 0.800；95%CI：0.780 - 0.820；P<0.001）的辨别能力在统计学上优于其他风险模型（所有P<0.001）。此外，所有临床评分在住院时间>72小时的患者中表现更好。在住院时间长于72小时的患者中，ICH-APS-B（0.827；95%CI：0.806 - 0.848；P<0.001）的辨别能力在统计学上仍优于其他风险模型。Hosmer-Lemeshow检验还显示，ICH-APS-B在ICH后院内SAP的Cox和Snell R2结果最大。
在5种预测ICH后SAP的模型中，ICH-APS-B表现出最佳的预测性能，表明它可能是实施患者个性化护理和开展ICH后SAP临床试验的有用工具。
