基于MEWS的急性脑卒中短期预后评分系统的构建及评价

Construction and evaluation of short-term prognosis scoring system for acute stroke based on MEWS

目的通过对影响急性脑卒中短期预后的临床危险因素的研究,并联合MEWS,构建急性脑卒中短期预后预测评分系统,为临床治疗和短期预后预测提供依据。方法回顾性研究广西医科大学第一附属医院2018年1月至2018年12月首次诊断急性脑卒中成人患者200例,随访30天,并按临床结局分为预后良好组及预后不良组。收集入院时可能影响患者短期预后相关的危险因素,应用单因素及多因素Logistic逐步向前法确定影响预后的临床危险因素,并根据OR值及β系数建立危险因素模块,与MEWS联合建立预后预测评分系统,最终应用ROC曲线检验其预测效能。结果(1)单因素分析显示,2组间年龄、白细胞水平、尿酸、红细胞分布宽度、入院血糖及CRP比较差异有统计学意义(P<0.05)。(2)采用Logistic回归筛选出影响急性脑卒中预后独立危险因素:年龄、白细胞、CRP,并进行赋值,联合MEWS形成脑卒中短期预后预测评分系统。(3)经ROC曲线分析,ROC曲线下面积为0.816(P<0.001),且当评分为7分时,预测效能最强。结论(1)年龄、入院时白细胞计数及CRP水平是影响急性脑卒中预后不良的独立危险因素。(2)预后预测评分系统可较为准确的预测急性脑卒中患者的预后。

Objective To study the clinical risk factors influencing short-term prognosis of acute cerebral apoplexy,and to construct a score system for short-term prognosis prediction of acute cerebral apoplexy in combination with MEWS,so as to provide a basis for clinical treatment and short-term prognosis prediction.Methods A retrospective study was conducted on 200 adult patients with acute stroke first diagnosed in the first affiliated hospital of guangxi medical university from January 2018 to December 2018.The patients were followed up for 30 days,and were divided into a good group and a bad group according to the clinical outcome.The risk factors that may affect short-term prognosis of patients at admission were collected,the clinical risk factors that affect prognosis were determined by using univariate and multivariate Logistic stepforward method,and the risk factor module was established according to OR value and coefficient,and the prognostic scoring system was jointly established with MEWS,and the predictive efficacy was finally tested by ROC curve.Results(1)univariate analysis showed statistically significant differences in age,white blood cell level,uric acid,red blood cell distribution width,admission blood glucose and CRP between the two groups(P<0.05).(2)Independent risk factors influencing the prognosis of acute stroke were screened out by Logistic regression,including age,white blood cells and CRP,and the values were assigned.Combined with MEWS,the score system for short-term prognosis prediction of stroke was formed.(3)through ROC curve analysis,the area under the ROC curve was 0.816(P<0.001),and when the score was 7,the prediction performance was the strongest.Conclusion(1)Age,white blood cell count and CRP level at admission were independent risk factors for poor prognosis of acute stroke.(2)the prognostic score system can accurately predict the prognosis of patients with acute stroke.