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开发并验证用于预测缺血性中风风险的列线图模型。

Developing and Validating a Nomogram Model for Predicting Ischemic Stroke Risk.

作者信息

Zhou Li, Wu Youlin, Wang Jiani, Wu Haiyun, Tan Yongjun, Chen Xia, Song Xiaosong, Wang Yilin, Yang Qin

机构信息

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

Department of Neurology, Chongzhou People's Hospital, Chengdu 611200, China.

出版信息

J Pers Med. 2024 Jul 22;14(7):777. doi: 10.3390/jpm14070777.

Abstract

: Clinically, the ability to identify individuals at risk of ischemic stroke remains limited. This study aimed to develop a nomogram model for predicting the risk of acute ischemic stroke. : In this study, we conducted a retrospective analysis on patients who visited the Department of Neurology, collecting important information including clinical records, demographic characteristics, and complete hematological tests. Participants were randomly divided into training and internal validation sets in a 7:3 ratio. Based on their diagnosis, patients were categorized as having or not having ischemic stroke (ischemic and non-ischemic stroke groups). Subsequently, in the training set, key predictive variables were identified through multivariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression methods, and a nomogram model was constructed accordingly. The model was then evaluated on the internal validation set and an independent external validation set through area under the receiver operating characteristic curve (AUC-ROC) analysis, a Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) to verify its predictive efficacy and clinical applicability. : Eight predictors were identified: age, smoking status, hypertension, diabetes, atrial fibrillation, stroke history, white blood cell count, and vitamin B12 levels. Based on these factors, a nomogram with high predictive accuracy was constructed. The model demonstrated good predictive performance, with an AUC-ROC of 0.760 (95% confidence interval [CI]: 0.736-0.784). The AUC-ROC values for internal and external validation were 0.768 (95% CI: 0.732-0.804) and 0.732 (95% CI: 0.688-0.777), respectively, proving the model's capability to predict the risk of ischemic stroke effectively. Calibration and DCA confirmed its clinical value. : We constructed a nomogram based on eight variables, effectively quantifying the risk of ischemic stroke.

摘要

临床上,识别缺血性中风风险个体的能力仍然有限。本研究旨在开发一种预测急性缺血性中风风险的列线图模型。

在本研究中,我们对神经内科就诊的患者进行了回顾性分析,收集了包括临床记录、人口统计学特征和完整血液学检查在内的重要信息。参与者以7:3的比例随机分为训练集和内部验证集。根据诊断结果,将患者分为患有或未患有缺血性中风(缺血性和非缺血性中风组)。随后,在训练集中,通过多变量逻辑回归和最小绝对收缩和选择算子(LASSO)回归方法确定关键预测变量,并据此构建列线图模型。然后通过受试者操作特征曲线下面积(AUC-ROC)分析、Hosmer-Lemeshow拟合优度检验和决策曲线分析(DCA)在内部验证集和独立的外部验证集上对模型进行评估,以验证其预测效能和临床适用性。

确定了八个预测因素

年龄、吸烟状况、高血压、糖尿病、心房颤动、中风病史、白细胞计数和维生素B12水平。基于这些因素,构建了具有高预测准确性的列线图。该模型表现出良好的预测性能,AUC-ROC为0.760(95%置信区间[CI]:0.736-0.784)。内部和外部验证的AUC-ROC值分别为0.768(95%CI:0.732-0.804)和0.732(95%CI:0.688-0.777),证明该模型能够有效预测缺血性中风风险。校准和DCA证实了其临床价值。

我们基于八个变量构建了列线图,有效量化了缺血性中风的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/152f/11277803/3bf8d014a752/jpm-14-00777-g002.jpg

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