中国卒中杂志2024，Vol.19Issue(5)：524-531,8.DOI:10.3969/j.issn.1673-5765.2024.05.007
轻型急性缺血性卒中患者院内神经功能恶化预测模型的开发与验证研究
Development and Validation of a Prediction Model of In-Hospital Neurological Deterioration for Patients with Minor Acute Ischemic Stroke
摘要
Abstract
Objective To develop a prediction model of in-hospital neurological deterioration for patients with minor acute ischemic stroke(AIS),and to provide scientific basis for stratified in-hospital management. Methods Patients with minor AIS(defined as NIHSS score≤5)enrolled in the China national stroke registry Ⅲ(CNSR Ⅲ)and arriving within 24 hours from onset while without taking rt-PA intravenous thrombolysis or endovascular treatment were selected as the study subjects.The derivation cohort was consisted of 2256 patients enrolled from 2015 to 2016,and the validation cohort was consisted of 1775 patients enrolled from 2017 to 2018.The predictors were finally determined by LASSO regression and reviewing of previous studies.In-hospital neurological deterioration was defined as 4 points or more increase in NIHSS score at discharge compared with the NIHSS score at admission.A logistic regression model was used to develop the prediction model.Discrimination and calibration were evaluated using C statistic and the Brier score,respectively. Results A total of 4031 patients were included in the study,with 58(2.6%)of 2256 patients from the derivation cohort and 63(3.5%)of 1775 patients from the validation cohort encountered in-hospital neurological deterioration.The population characteristics were similar between the two cohorts.The prediction model was developed based on 9 predictors,including age,gender,smoking,systolic blood pressure,IL-6,hs-CRP,NIHSS score on admission,diabetes mellitus and infarction pattern.The C statistic for the model was 0.69(95%CI 0.62-0.76)in the derivation cohort and 0.73(95%CI 0.67-0.80)in the validation cohort.The Brier score of the model was 0.025 in the derivation cohort and 0.033 in the validation cohort. Conclusions This study developed a prediction model for the risk of in-hospital neurological deterioration for patients with minor AIS based on routine hospitalization data,and the prediction model achieved acceptable levels of discrimination and calibration,yet the extrapolation needs to be further verified by external data.关键词
急性缺血性卒中/神经功能恶化/预测模型/医疗管理Key words
Acute ischemic stroke/Neurological deterioration/Prediction model/Medical management分类
医药卫生引用本文复制引用
伊珞,姜英玉,孟霞,姜勇,王拥军,谷鸿秋..轻型急性缺血性卒中患者院内神经功能恶化预测模型的开发与验证研究[J].中国卒中杂志,2024,19(5):524-531,8.基金项目
国家自然科学基金项目(72004146)北京市医院管理中心"青苗"人才计划(QML20210501)北京市医院管理中心"培育"人才计划(PX2021024) （72004146）
