A new nomogram for predicting 90-day outcomes of intravenous thrombolysis in patients with acute ischaemic stroke.

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Frontiers in Neurology Pub Date : 2025-02-27 eCollection Date: 2025-01-01 DOI:10.3389/fneur.2025.1512913

Yingjie Zhao, Rui Zhang, Pan Li, Zhen Zhang, Huan Yu, Zhaoya Su, Yandong Xia, Aiguo Meng

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Abstract

Background: The aim of this study was to construct and validate a new nomogram to predict the risk of poor outcome in patients with acute ischemic stroke (AIS) after intravenous thrombolytic therapy (IVT).

Methods: A total of 425 patients who received IVT within 4.5 h of stroke onset were included in a retrospective study. All the patients were divided into training (70%, n = 298) and validation cohorts (30%, n = 127). Poor outcome (defined as a 90-day modified Rankin Scale score 3-5) was the primary outcome. Logistic regression was used for analysis of independent risk factors for poor outcome in patients with AIS. Nomograms of poor outcome in AIS patients were constructed using R software. Discrimination and calibration of the models were assessed using area under the receiver operating characteristic (ROC) curve (AUC) and calibration plots.

Results: Multifactorial logistic regression analysis showed that SII (OR = 1.001, 95% CI: 1.000-1.002, p = 0.008), SIRI (OR = 1.584, 95% CI: 1.122-2.236, p = 0.009), NIHSS (OR = 1.101, 95% CI: 1.044-1.160, p < 0.001), and history of diabetes mellitus (OR = 2.582, 95% CI: 1.285-5.188, p = 0.008) were the independent risk factors for the occurrence of poor outcome in AIS patients. The poor outcome nomogram for AIS patients was constructed based on the above independent risk factors. The training and validation cohort AUCs of the nomogram were 0.854 (95% CI: 0.807-0.901) and 0.855 (95% CI: 0.783-0.927), respectively. The prediction models were well calibrated in both the training and validation cohorts. The net benefit of the nomograms was better when the threshold probability ranges were 4.28-66.4% and 4.01-67.8% for the training and validation cohorts, respectively.

Conclusion: New nomogram includes NIHSS, SII, SIRI and diabetes as variables with the potential to predict the risk of 90-day outcomes in patients with AIS following IVT.

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背景：本研究旨在构建并验证一种新的提名图，用于预测急性缺血性脑卒中（AIS）患者静脉溶栓治疗（IVT）后的不良预后风险：本研究旨在构建并验证一种新的提名图，用于预测急性缺血性卒中（AIS）患者静脉溶栓治疗（IVT）后不良预后的风险：这项回顾性研究共纳入了 425 名在卒中发生后 4.5 小时内接受静脉溶栓治疗的患者。所有患者被分为训练组（70%，n = 298）和验证组（30%，n = 127）。不良预后（定义为 90 天改良 Rankin 量表评分 3-5 分）是主要预后。逻辑回归用于分析 AIS 患者不良预后的独立风险因素。使用 R 软件构建了 AIS 患者不良预后的提名图。使用接收者操作特征曲线（ROC）下面积（AUC）和校准图评估模型的辨别和校准：多因素逻辑回归分析显示，SII（OR = 1.001，95% CI：1.000-1.002，p = 0.008）、SIRI（OR = 1.584，95% CI：1.122-2.236，p = 0.009）、NIHSS（OR = 1.101，95% CI：1.044-1.160，p = 0.008）是AIS患者不良预后发生的独立危险因素。根据上述独立风险因素构建了 AIS 患者不良预后提名图。提名图的训练队列和验证队列AUC分别为0.854（95% CI：0.807-0.901）和0.855（95% CI：0.783-0.927）。预测模型在训练组和验证组中都得到了很好的校准。当训练队列和验证队列的阈值概率范围分别为 4.28-66.4% 和 4.01-67.8% 时，提名图的净效益更好：新的提名图包括 NIHSS、SII、SIRI 和糖尿病等变量，这些变量具有预测 IVT 后 AIS 患者 90 天预后风险的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Neurology CLINICAL NEUROLOGYNEUROSCIENCES -NEUROSCIENCES

CiteScore

4.90

自引率

8.80%

发文量

2792

审稿时长

14 weeks

期刊介绍： The section Stroke aims to quickly and accurately publish important experimental, translational and clinical studies, and reviews that contribute to the knowledge of stroke, its causes, manifestations, diagnosis, and management.