Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China.
Clin Neurol Neurosurg. 2024 Apr;239:108220. doi: 10.1016/j.clineuro.2024.108220. Epub 2024 Mar 2.
The systemic inflammation score (SIS) has been utilised as a representative biomarker for evaluating nutritional and inflammation status. However, the predictive value of SIS has not been reported in patients with acute ischemic stroke (AIS). We aimed to evaluate whether SIS is associated with prognosis in stroke.
A total of 4801 patients with AIS were included in the study. The primary outcome was a modified Rankin Scale score>2 at the 3-month follow-up. A total of 4801 patients were randomly allocated into training (n=3361) and validation cohorts (n=1440) at a ratio of 7:3. Model performance was validated using the receiver operating characteristic (ROC) curve and calibration curve. Additionally, a comparison was made between the nomogram and the THRIVE score in regards to their respective predictive capabilities.
Overall, 1091(32.5%) patients in the training cohort and 446 (31.0%) patients in the validation cohort experienced an unfavorable outcome. The multivariate logistic regression analysis revealed that a high SIS, age, NIHSS, diabetes and prior stroke were associated with unfavorable outcome. Our nomogram was developed based on the variables mentioned above. The area under the curve (AUC) of the training set and the validation set are 0.702 and 0.708, respectively, indicating that the model has modest agreement and discrimination. The results of AUC, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) showed that nomogram had significantly higher predictive value than THRIVE scores (all P<0.001). However, unlike the THRIVE publication, all patients who had undergone intravenous thrombolysis or endovascular thrombectomy therapy were excluded in our study. In consequence, our derived THRIVE scores cannot be compared to those in the original THRIVE study.
The SIS exhibits potential as a simple prognostic biomarker, and the nomogram, which utilizes the SIS, may serve as a valuable tool for clinicians in the early identification of patients at heightened risk for unfavorable outcomes.
全身炎症评分（SIS）已被用作评估营养和炎症状态的代表性生物标志物。然而，SIS 在急性缺血性脑卒中（AIS）患者中的预测价值尚未报道。我们旨在评估 SIS 是否与脑卒中预后相关。
本研究共纳入 4801 例 AIS 患者。主要结局为 3 个月随访时改良 Rankin 量表评分>2。4801 例患者按 7:3 的比例随机分配到训练队列（n=3361）和验证队列（n=1440）。采用受试者工作特征（ROC）曲线和校准曲线验证模型性能。此外，还比较了列线图和 THRIVE 评分在预测能力方面的差异。
在训练队列中，共有 1091 例（32.5%）患者和验证队列中 446 例（31.0%）患者预后不良。多变量逻辑回归分析显示，高 SIS、年龄、NIHSS、糖尿病和既往脑卒中与预后不良相关。我们的列线图是基于上述变量建立的。训练集和验证集的曲线下面积（AUC）分别为 0.702 和 0.708，表明模型具有中等一致性和区分度。AUC、净重新分类改善（NRI）和综合判别改善（IDI）的结果表明，列线图的预测价值明显高于 THRIVE 评分（均 P<0.001）。然而，与 THRIVE 出版物不同，我们的研究排除了所有接受静脉溶栓或血管内取栓治疗的患者。因此，我们得出的 THRIVE 评分不能与原始 THRIVE 研究中的评分进行比较。
SIS 作为一种简单的预后生物标志物具有潜力，使用 SIS 的列线图可能成为临床医生早期识别预后不良风险较高患者的有用工具。
