Jiang Yi, Xie Chunhui, Zhang Guanghui, Liu Mengqian, Xu Yiwen, Zhong Wen, Ge Zhonglin, Tao Zhonghai, Qian Mingyue, Gong Chen, Shen Xiaozhu
Department of Geriatrics, Bengbu Medical College Clinical College of Lianyungang Second People's Hospital, Lianyungang, China.
Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China.
Front Neurol. 2023 Jun 15;14:1139446. doi: 10.3389/fneur.2023.1139446. eCollection 2023.
Many patients with acute ischemic stroke (AIS) cannot undergo thrombolysis or thrombectomy because they have missed the time window or do not meet the treatment criteria. In addition, there is a lack of an available tool to predict the prognosis of patients with standardized treatment. This study aimed to develop a dynamic nomogram to predict the 3-month poor outcomes in patients with AIS.
This was a retrospective multicenter study. We collected the clinical data of patients with AIS who underwent standardized treatment at the First People's Hospital of Lianyungang from 1 October 2019 to 31 December 2021 and at the Second People's Hospital of Lianyungang from 1 January 2022 to 17 July 2022. Baseline demographic, clinical, and laboratory information of patients were recorded. The outcome was the 3-month modified Rankin Scale (mRS) score. The least absolute shrinkage and selection operator regression were used to select the optimal predictive factors. Multiple logistic regression was performed to establish the nomogram. A decision curve analysis (DCA) was applied to assess the clinical benefit of the nomogram. The calibration and discrimination properties of the nomogram were validated by calibration plots and the concordance index.
A total of 823 eligible patients were enrolled. The final model included gender (male; OR 0.555; 95% CI, 0.378-0.813), systolic blood pressure (SBP; OR 1.006; 95% CI, 0.996-1.016), free triiodothyronine (FT3; OR 0.841; 95% CI, 0.629-1.124), National Institutes of Health stroke scale (NIHSS; OR 18.074; 95% CI, 12.264-27.054), Trial of Org 10172 in Acute Stroke Treatment (TOAST; cardioembolic (OR 0.736; 95% CI, 0.396-1.36); and other subtypes (OR 0.398; 95% CI, 0.257-0.609). The nomogram showed good calibration and discrimination (C-index, 0.858; 95% CI, 0.830-0.886). DCA confirmed the clinical usefulness of the model. The dynamic nomogram can be obtained at the website: predict model (90-day prognosis of AIS patients).
We established a dynamic nomogram based on gender, SBP, FT3, NIHSS, and TOAST, which calculated the probability of 90-day poor prognosis in AIS patients with standardized treatment.
许多急性缺血性卒中（AIS）患者因错过时间窗或不符合治疗标准而无法接受溶栓或取栓治疗。此外，缺乏一种可用工具来预测接受标准化治疗患者的预后。本研究旨在开发一种动态列线图，以预测AIS患者3个月时的不良结局。
这是一项回顾性多中心研究。我们收集了2019年10月1日至2021年12月31日在连云港市第一人民医院以及2022年1月1日至2022年7月17日在连云港市第二人民医院接受标准化治疗的AIS患者的临床资料。记录患者的基线人口统计学、临床和实验室信息。结局指标为3个月改良Rankin量表（mRS）评分。采用最小绝对收缩和选择算子回归来选择最佳预测因素。进行多因素逻辑回归以建立列线图。应用决策曲线分析（DCA）评估列线图的临床获益。通过校准图和一致性指数验证列线图的校准和区分性能。
共纳入823例符合条件的患者。最终模型包括性别（男性；OR 0.555；95%CI，0.378 - 0.813）、收缩压（SBP；OR 1.006；95%CI，0.996 - 1.016）、游离三碘甲状腺原氨酸（FT3；OR 0.841；95%CI，0.629 - 1.124）、美国国立卫生研究院卒中量表（NIHSS；OR 18.074；95%CI，12.264 - 27.054）、急性卒中治疗中组织纤溶酶原激活剂10172试验（TOAST；心源性栓塞（OR 0.736；95%CI，0.396 - 1.36）；以及其他亚型（OR 0.398；95%CI，0.257 - 0.609）。列线图显示出良好的校准和区分性能（C指数，0.858；95%CI，0.830 - 0.886）。DCA证实了该模型的临床实用性。可在网站：预测模型（AIS患者90天预后）获取动态列线图。
我们基于性别、SBP、FT3、NIHSS和TOAST建立了一种动态列线图，用于计算接受标准化治疗的AIS患者90天不良预后的概率。
