GNRI、PLR 和卒中相关性肺炎：从关联到基于网络的动态列线图的开发。
GNRI, PLR and Stroke-Associated Pneumonia: From Association to Development of a Web-Based Dynamic Nomogram.
机构信息
Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People's Republic of China.
出版信息
Clin Interv Aging. 2023 Nov 17;18:1893-1904. doi: 10.2147/CIA.S433388. eCollection 2023.
OBJECTIVE
Discussing the relationship between geriatric nutritional risk index (GNRI) and platelet-to-lymphocyte ratio (PLR) on stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients, developing and validating a web-based dynamic nomogram.
METHODS
A total of 996 AIS patients admitted to the Department of General Medicine and Neurology at Xuzhou Medical University Affiliated Hospital were collected. They were divided into Non-SAP group and SAP group based on the occurrence of SAP. The data was randomly divided into training set and validation set in a ratio of 7:3. LASSO regression and multivariable logistic regression analysis were used to screen for independent risk factors and develop a dynamic nomogram. Area under the receiver operating characteristic curve (AUC-ROC), calibration curve, and decision curve analysis (DCA) curve were used to validate the model's discriminative ability, calibration, and clinical value, respectively.
RESULTS
Among AIS patients, a total of 221 cases (22.19%) developed SAP. Age, NIHSS score, comorbid atrial fibrillation, dysphagia, PLR, and GNRI were identified as independent factors influencing the occurrence of SAP in AIS patients. A web-based dynamic nomogram was developed based on these six variables. The training set showed an AUC-ROC of 0.864 (95% CI: 0.828-0.892), while the validation set showed an AUC-ROC of 0.825 (95% CI: 0.772-0.882), indicating good predictive ability and discrimination of the model. The calibration curve demonstrated good calibration of the model, and the DCA curve showed its clinical value. This model can be accessed and utilized by anyone on the website (https://moonlittledoctor.shinyapps.io/ANADPG/).
CONCLUSION
PLR and GNRI are independent factors influencing the occurrence of SAP in AIS patients, and a dynamic nomogram was constructed to predict the risk of SAP in AIS patients. It can guide clinical decision-making and improve patient prognosis.
目的
探讨老年营养风险指数（GNRI）与血小板与淋巴细胞比值（PLR）与急性缺血性脑卒中（AIS）患者卒中相关性肺炎（SAP）的关系，建立并验证基于网络的动态列线图。
方法
收集徐州医科大学附属医院综合医学科和神经科收治的 996 例 AIS 患者，根据 SAP 的发生情况将其分为非 SAP 组和 SAP 组。采用 LASSO 回归和多因素 logistic 回归分析筛选独立危险因素，并建立动态列线图。采用受试者工作特征曲线（ROC）下面积（AUC-ROC）、校准曲线和决策曲线分析（DCA）曲线分别验证模型的判别能力、校准度和临床价值。
结果
AIS 患者中共有 221 例（22.19%）发生 SAP。年龄、NIHSS 评分、合并心房颤动、吞咽困难、PLR 和 GNRI 是影响 AIS 患者发生 SAP 的独立因素。基于这 6 个变量建立了一个基于网络的动态列线图。训练集的 AUC-ROC 为 0.864（95%CI：0.828-0.892），验证集的 AUC-ROC 为 0.825（95%CI：0.772-0.882），表明该模型具有良好的预测能力和区分度。校准曲线表明该模型具有良好的校准度，DCA 曲线表明其具有临床价值。任何人都可以在网站上访问和使用该模型（https://moonlittledoctor.shinyapps.io/ANADPG/）。
结论
PLR 和 GNRI 是影响 AIS 患者 SAP 发生的独立因素，构建了预测 AIS 患者 SAP 风险的动态列线图，可以指导临床决策，改善患者预后。
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