不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较

Prediction of Short-and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems

目的比较缺血性卒中风险预测评分(iScore),住院前并发症、意识水平、年龄和局灶性神经功能缺损评分(PLAN),洛桑急性缺血性脑卒中登记评分(ASTRAL)和血管事件患者总体健康风险评分(THRIVE)对急性缺血性脑卒中(AIS)患者30 d、3个月和1年死亡风险的预测能力。方法2015年8月~2018年6月,连续纳入本院急诊病房AIS患者323例,以入组时间为起点,分别于30 d、3个月、1年后随访,应用受试者工作特征曲线(ROC)评价iScore、PLAN、ASTRAL和THRIVE对死亡风险的预测作用。结果AIS患者30 d、3个月、1年的全因死亡率分别为12.4%(40/323)、17.3%(56/323)和25.7%(83/323)。4种评分系统曲线下面积(AUC)从大到小依次为iScore、PLAN、ASTRAL和THRIVE,其中iScore与THRIVE之间有显著性差异(Z>1.990,P<0.05),其他评分系统间无显著性差异(Z<1.943,P>0.05)。结论iScore、PLAN、ASTRAL和THRIVE均能有效预测急诊病房AIS患者短期和长期死亡风险,以iScore最优。但iScore计算程序相对复杂,PLAN和ASTRAL更适用于急诊科应用。

Objective To compare the prediction of Ischemic Stroke Predictive Risk Score(iScore),Preadmission Comorbidities,Level of Consciousness,Age,and Neurologic Deficit(PLAN),Acute Stroke Registry and Analysis of Lausanne(ASTRAL)and Totaled Health Risks in Vascular Events(THRIVE)for short-and long-term death for patients with acute ischemic stroke(AIS).Methods From August,2015 to June,2018,323 AIS patients in emergency ward were included,and followed up 30 days,three months and a year after including.Receiver operating characteristic(ROC)curve was used to analyze the predictive effects of iScore,PLAN,ASTRAL and THRIVE.Results The all-cause mortality 30 days,three months and a year after including was 12.4%(40/323),17.3%(56/323)and 25.7%(83/323),respectively.The area under curve(AUC)from more to less arranged as iScore,PLAN,ASTRAL and THRIVES.There was significant difference of AUC between iScore and THRIVE(Z>1.990,P<0.05),but not among the others(Z<1.943,P>0.05).Conclusion iScore,PLAN,ASTRAL and THRIVE may predict short-and long-term death of AIS patients in the emergency well,and iScore is the best.However,the procedure of iScore is complex,it is recommended to use PLAN and ASTRAL for emergency.