He Qian, Wang Miaoran, Zhu Haoyue, Xiao Ying, Wen Rui, Liu Xiaoqing, Shi Yangdi, Zhang Linzhi, Xu Bing
Qionglai Traditional Chinese Medicine Hospital, Chengdu, China.
Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China.
Front Neurol. 2025 Jan 30;15:1487248. doi: 10.3389/fneur.2024.1487248. eCollection 2024.
This study aimed to develop and validate a nomogram for predicting the risk of 3 months adverse outcomes among young adults with acute ischemic stroke (AIS).
Patients aged between 18 and 50 with acute ischemic stroke (AIS) at the Shenyang First's People Hospital, between January 1st 2017 to May 30th 2023 were included in this retrospective study. The primary outcome was a three-month unfavorable outcome, evaluated with modified Rankin Scale (mRS > 2). Univariate logistic regression was used to select the independent factors of prognosis and multivariate logistic regression to establish a new nomogram model. We used the area under the receiver-operating characteristic curve (ROC) to evaluate the discriminative performance and used the calibration curve with Hosmer-Lemeshow goodness of fit test to assess the calibration performance of the risk prediction model. Decision curve analysis (DCA) was applied to assess the clinical utility of the nomogram.
A total of 1,015 patients were enrolled. Gender (male vs. female; Odds ratio[OR], 0.5562[95% Confidence Interval (CI), 0.3104-1.0478]; = 0.053), family history of stroke (OR, 3.5698[95%CI 1.5632-8.0329], < 0.001), prior stroke (OR, 2.1509[95%CI 1.2610-3.6577], < 0.001), previous heart disease (OR, 3.4047[95%CI, 1.7838-6.6976], < 0.01) toast type (cardio-embolism stroke vs. large-artery atherosclerosis (LAA), OR, 0.0847[0.0043-0.5284], < 0.01), toast type (stroke of undetermined etiology vs. LAA, OR, 0.0847[0.0439-0.5284], < 0.01), mRS at admission (OR, 15.2446 [9.1447-26.3156], < 0.0001), adherence to medication (OR, 2.1197[95%CI, 1.1924-3.7464], < 0.001), systolic blood pressure (SBP; OR, 1.0145[1.0041-1.0250], < 0.001), and lactate dehydrogenase (LDH; OR, 1.0060[1.0010-1.0111], < 0.01) were related to 3 months adverse outcomes among young adults with AIS. The nomogram displayed excellent calibration and discrimination. DCA confirmed the clinical applicability of the model.
The nomogram comprised of gender, family history of stroke, prior stroke, previous heart disease, toast type, mRS score at admission, adherence to medication, SBP and LDH may predict 3 months adverse outcomes among young adults with AIS.
本研究旨在开发并验证一种列线图，用于预测急性缺血性卒中（AIS）青年患者3个月不良结局的风险。
本回顾性研究纳入了2017年1月1日至2023年5月30日期间在沈阳市第一人民医院就诊的18至50岁急性缺血性卒中（AIS）患者。主要结局为3个月时的不良结局，采用改良Rankin量表（mRS＞2）进行评估。单因素逻辑回归用于选择预后的独立因素，多因素逻辑回归用于建立新的列线图模型。我们使用受试者操作特征曲线（ROC）下面积评估鉴别性能，并使用校准曲线及Hosmer-Lemeshow拟合优度检验评估风险预测模型的校准性能。应用决策曲线分析（DCA）评估列线图的临床实用性。
共纳入1015例患者。性别（男性与女性；比值比[OR]，0.5562[95%置信区间（CI），0.3104 - 1.0478]；P = 0.053）、卒中家族史（OR，3.5698[95%CI 1.5632 - 8.0329]，P＜0.001）、既往卒中史（OR，2.1509[95%CI 1.2610 - 3.6577]，P＜0.001）、既往心脏病史（OR，3.4047[95%CI，1.7838 - 6.6976]，P＜0.01）、TOAST分型（心源性栓塞性卒中与大动脉粥样硬化性（LAA）卒中，OR，0.0847[0.0043 - 0.5284]，P＜0.01）、TOAST分型（病因不明性卒中与LAA卒中，OR，0.0847[0.0439 - 0.5284]，P＜0.01）、入院时mRS评分（OR，15.2446 [9.1447 - 26.3156]，P＜0.0001）、服药依从性（OR，2.1197[95%CI，1.1924 - 3.7464]，P＜0.001）、收缩压（SBP；OR，1.0145[1.0041 - 1.0250]，P＜0.001）和乳酸脱氢酶（LDH；OR，1.0060[1.0010 - 1.0111]，P＜0.01）与AIS青年患者3个月不良结局相关。该列线图显示出良好的校准和鉴别性能。DCA证实了该模型的临床适用性。
由性别、卒中家族史、既往卒中史、既往心脏病史、TOAST分型、入院时mRS评分、服药依从性、SBP和LDH组成的列线图可预测AIS青年患者3个月的不良结局。
