Haiyong Zeng, Wencai Li, Yunxiang Zhou, Shaohuai Xia, Kailiang Zeng, Ke Xu, Wenjie Qiu, Gang Zhu, Jiansheng Chen, Yifan Deng, Zhongzong Qin, Huanpeng Li, Honghai Luo
Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China.
Department of Neurosurgery, Affliated Hospital of Guilin Medical University, Guilin, China.
World Neurosurg. 2023 Apr;172:e39-e51. doi: 10.1016/j.wneu.2022.11.117. Epub 2022 Nov 29.
Patients with large artery occlusion-acute ischemic stroke (LAO-AIS) can experience adverse outcomes, such as brain herniation due to complications. This study aimed to construct a nomogram prediction model for prognosis in patients with LAO-AIS in order to maximize the benefits for clinical patients.
Retrospective analysis of 243 patients with LAO-AIS from January 2019 to January 2022 with medical history data and blood examination at admission. Univariate and multivariate analyses were conducted through binary logistic regression equation analysis, and a nomogram prediction model was constructed.
Results of this study showed that hyperlipidemia (odds ratio [OR] = 2.849, 95% confidence interval [CI] = 1.100-7.375, P = 0.031), right cerebral infarction (OR = 2.144, 95% CI = 1.106-4.156, P = 0.024), D-Dimer>500 ng/mL (OR = 2.891, 95% CI = 1.398-5.980, P = 0.004), and neutrophil-lymphocyte ratio >7.8 (OR = 2.149, 95% CI = 1.093-4.225, P = 0.027) were independent risk factors for poor early prognosis in patients with LAO-AIS. In addition, hypertension (OR = 1.947, 95% CI = 1.114-3.405, P = 0.019), hyperlipidemia (OR = 2.594, 95% CI = 1.281-5.252, P = 0.008), smoking (OR = 2.414, 95% CI = 1.368-4.261, P = 0.002), D-dimer>500 ng/mL (OR = 3.170, 95% CI = 1.533-6.553, P = 0.002), and neutrophil-lymphocyte ratio >7.8 (OR = 2.144, 95% CI = 1.231-3.735, P = 0.007) were independent risk factors for poor long-term prognosis. The early prognosis nomogram receiver operating characteristic curve area under the curve value was 0.688 for the training set and 0.805 for the validation set, which was highly differentiated. The mean error was 0.025 for the training set calibration curve and 0.016 for the validation set calibration curve. Both the training and validation set decision curve analyses indicated that the clinical benefit of the nomogram was significant. The long-term prognosis nomogram receiver operating characteristic curve area under the curve values was 0.697 for the training set and 0.735 for the validation set, showing high differentiation. The mean error was 0.041 for the training set calibration curve and 0.021 for the validation set calibration curve. Both of the training and validation set decision curve analyses demonstrated a substantial clinical benefit of the nomogram.
The nomogram prediction model based on admission history data and blood examination are easy-to-use tools that provide an accurate individualized prediction for patients with LAO-AIS and can assist in early clinical decisions and in obtaining an early prognosis.
大动脉闭塞性急性缺血性卒中（LAO - AIS）患者可能会出现不良后果，如因并发症导致脑疝。本研究旨在构建LAO - AIS患者预后的列线图预测模型，以最大程度地为临床患者带来益处。
回顾性分析2019年1月至2022年1月期间243例LAO - AIS患者的病史数据及入院时的血液检查结果。通过二元逻辑回归方程分析进行单因素和多因素分析，并构建列线图预测模型。
本研究结果显示，高脂血症（比值比[OR]=2.849，95%置信区间[CI]=1.100 - 7.375，P = 0.031）、右侧脑梗死（OR = 2.144，95% CI = 1.106 - 4.156，P = 0.024）、D - 二聚体>500 ng/mL（OR = 2.891，95% CI = 1.398 - 5.980，P = 0.004）以及中性粒细胞与淋巴细胞比值>7.8（OR = 2.149，95% CI = 1.093 - 4.225，P = 0.027）是LAO - AIS患者早期预后不良的独立危险因素。此外，高血压（OR = 1.947，95% CI = 1.114 - 3.405，P = 0.019）、高脂血症（OR = 2.594，95% CI = 1.281 - 5.252，P = 0.008）、吸烟（OR = 2.414，95% CI = 1.368 - 4.261，P = 0.002）、D - 二聚体>500 ng/mL（OR = 3.170，95% CI = 1.533 - 6.553，P = 0.002）以及中性粒细胞与淋巴细胞比值>7.8（OR = 2.144，95% CI = 1.231 - 3.735，P = 0.007）是长期预后不良的独立危险因素。早期预后列线图训练集的受试者操作特征曲线下面积值为0.688，验证集为0.805，具有高度区分度。训练集校准曲线的平均误差为0.025，验证集校准曲线的平均误差为0.016。训练集和验证集决策曲线分析均表明列线图具有显著的临床益处。长期预后列线图训练集的受试者操作特征曲线下面积值为0.697，验证集为0.735，显示出高区分度。训练集校准曲线的平均误差为0.041，验证集校准曲线的平均误差为0.021。训练集和验证集决策曲线分析均证明列线图具有显著的临床益处。
基于入院病史数据和血液检查的列线图预测模型是易于使用的工具，可为LAO - AIS患者提供准确的个体化预测，并有助于早期临床决策和获得早期预后。
