Department of Emergency, Baoding NO.1 Central Hospital, Baoding, Hebei, China.
Department of Neurology, Hebei Medical University, Shijiazhuang, Hebei, China.
BMJ Open. 2024 Jul 24;14(7):e079428. doi: 10.1136/bmjopen-2023-079428.
This study is to establish a nomination graph model for individualised early prediction of the 3-month prognosis of patients who had an acute ischaemic stroke (AIS) receiving intravenous thrombolysis with recombinant tissue plasminogen activator.
For the period from January 2016 through August 2022, 991 patients who had an acute stroke eligible for intravenous thrombolysis were included in the retrospective analysis study. The study was based on multifactor logistic regression.
Patients who received treatment from January 2016 to February 2021 were included in the training cohort, and those who received treatment from March 2021 to August 2022 were included in the testing cohort.
Each patient received intravenous thrombolysis within 4.5 hours of onset, with treatment doses divided into standard doses (0.9 mg/kg).
The primary outcome measure was a 3-month adverse outcome (modified Rankin Scale 3-6).
The National Institutes of Health Stroke Scale Score after thrombolysis (OR=1.18; 95% CI: 1.04 to 1.36; p = 0.015), door-to-needle time (OR=1.01; 95% CI: 1.00 to 1.02; p = 0.003), baseline blood glucose (OR=1.08; 95% CI: 1.00 to 1.16; p=0.042), blood homocysteine (OR=7.14; 95% CI: 4.12 to 12.71; p<0.001), monocytes (OR=0.05; 95% CI: 0.01 to 0.043; p=0.005) and monocytes/high-density lipoprotein (OR=62.93; 95% CI: 16.51 to 283.08; p<0.001) were independent predictors of adverse outcomes 3 months after intravenous thrombolysis, and the above six factors were included in the nominated DGHM2N nomogram. The area under the receiver operating characteristic curve value of the training cohort was 0.870 (95% CI: 0.841 to 0.899) and in the testing cohort was 0.822 (95% CI: 0.769 to 0.875).
A reliable nomogram model (DGHM2N model) was developed and validated in this study. This nomogram could individually predict the adverse outcome of patients who had an AIS receiving intravenous thrombolysis with alteplase for 3 months.
本研究旨在建立一个提名图模型，用于个体化预测接受重组组织型纤溶酶原激活物静脉溶栓治疗的急性缺血性脑卒中（AIS）患者 3 个月预后。
回顾性分析研究纳入了 2016 年 1 月至 2022 年 8 月期间 991 例适合静脉溶栓治疗的急性脑卒中患者。研究基于多因素逻辑回归。
接受 2016 年 1 月至 2021 年 2 月治疗的患者纳入训练队列，接受 2021 年 3 月至 2022 年 8 月治疗的患者纳入测试队列。
每位患者在发病后 4.5 小时内接受静脉溶栓治疗，治疗剂量分为标准剂量（0.9mg/kg）。
主要结局测量是 3 个月时的不良结局（改良 Rankin 量表 3-6）。
溶栓后美国国立卫生研究院卒中量表评分（OR=1.18；95%CI：1.04 至 1.36；p=0.015）、门到针时间（OR=1.01；95%CI：1.00 至 1.02；p=0.003）、基线血糖（OR=1.08；95%CI：1.00 至 1.16；p=0.042）、血同型半胱氨酸（OR=7.14；95%CI：4.12 至 12.71；p<0.001）、单核细胞（OR=0.05；95%CI：0.01 至 0.043；p=0.005）和单核细胞/高密度脂蛋白（OR=62.93；95%CI：16.51 至 283.08；p<0.001）是静脉溶栓后 3 个月不良结局的独立预测因素，上述六个因素纳入了提名的 DGHM2N 列线图。训练队列的受试者工作特征曲线下面积为 0.870（95%CI：0.841 至 0.899），测试队列为 0.822（95%CI：0.769 至 0.875）。
本研究建立并验证了一个可靠的列线图模型（DGHM2N 模型）。该列线图可个体化预测接受阿替普酶静脉溶栓治疗的 AIS 患者 3 个月的不良结局。
