Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
J Neurol. 2022 Dec;269(12):6428-6435. doi: 10.1007/s00415-022-11277-7. Epub 2022 Aug 4.
We aimed to develop a score and validate it in a prospective cohort to identify the patients with ESUS at high risk for stroke recurrence.
We assessed the stroke recurrence in ESUS patients of the Third China National Stroke Registry. We performed multivariable logistic regression analysis to identify predictors of stroke recurrence in the derivation cohort. Based on the coefficient of each covariate of the fitted multivariable model, we generated an integer-based point scoring system. We validated the score in the validation cohort assessing its discrimination and calibration.
2415 patients were included: 1611 in the derivation and 804 in the validation sample. We developed a scoring system (0-15 points) by assigning 2 points for hypertension, 3 points for diabetes mellitus, 4 points for multiple stage infarction, 2 points for watershed involved infarction, 1 points for left atrial diameter index (per increasing 2.5 mm/m2) and 3 points for without statin at discharge. The rate of stroke recurrence was 5.9% per year (95% CI 4.2-7.6%) in patients with low risk(a score of 0-5), 9.4% (7.3-11.5%) in patients with intermediate risk (6-10), and 26.8% (16.5-37.1%) in patients with high risk (11-15). The AUC (area under curve of receiver operator characteristic curve) of the score in the derivation cohort and validation cohort was, respectively, 0.60 (0.55-0.65) and 0.63 (0.56-0.70). The score was well calibrated both in the derivation cohort (p = 0.36) and validation cohort (p = 0.26) with the Hosmer-Lemeshow test.
The developed score can improve risk stratification after ESUS in secondary care settings.
我们旨在开发一种评分系统，并在前瞻性队列中验证其识别 ESUS 患者发生卒中复发风险的能力。
我们评估了第三届中国国家卒中登记研究中 ESUS 患者的卒中复发情况。我们对首发队列进行多变量逻辑回归分析以识别卒中复发的预测因素。基于拟合多变量模型中每个协变量的系数，我们生成了一个基于整数的评分系统。我们在验证队列中验证了该评分系统，评估其区分度和校准度。
共纳入 2415 例患者：其中 1611 例来自推导队列，804 例来自验证队列。我们开发了一种评分系统（0-15 分），其中高血压计 2 分，糖尿病计 3 分，多部位梗死计 4 分，分水岭区梗死计 2 分，左心房直径指数（每增加 2.5mm/m2）计 1 分，出院时未使用他汀类药物计 3 分。低危组（评分 0-5 分）患者的卒中复发率为每年 5.9%（95%CI 4.2-7.6%），中危组（评分 6-10 分）患者为 9.4%（7.3-11.5%），高危组（评分 11-15 分）患者为 26.8%（16.5-37.1%）。评分在推导队列和验证队列的 AUC（受试者工作特征曲线下面积）分别为 0.60（0.55-0.65）和 0.63（0.56-0.70）。该评分在推导队列（p=0.36）和验证队列（p=0.26）中均具有良好的校准度（Hosmer-Lemeshow 检验）。
该评分系统可改善二级医疗环境中 ESUS 后的风险分层。
