GAND评分评估急性缺血性脑卒中病人短期预后的临床价值

Efficacy of GAND Score in Short-term Prognosis Assessment of Patients with Acute Ischemic Stroke

目的:探讨简易急性卒中(GAND)评分评估急性缺血性脑卒中(AIS)病人预后的临床价值。方法:回顾性连续纳入2020年1月—2021年1月于成都市第二人民医院急诊科就诊并入院治疗的AIS病人。收集急诊入院时病人的基本资料、入院时实验室检查资料。根据收集的资料计算入院时美国国立卫生研究院卒中量表(NIHSS)评分、洛桑急性卒中登记量表(ASTRAL)评分、缺血性卒中风险预测评分(IScore)。运用改良Rankin量表(mRS)评分评估病人出院后3个月的神经功能。运用Logistic分析筛选影响病人预后不良的指标,构建GAND评分,并采用受试者工作特征曲线(ROC)比较GAND评分与ASTRAL评分、IScore评分预测AIS病人预后的效力。结果:本研究共纳入312例AIS病人。Logistic回归分析显示:心房颤动史、入院时收缩压(SBP)、血糖(Glu)、中性粒细胞计数与淋巴细胞计数比值(NLR)、D-二聚体(D-dimer)是病人预后的独立危险因素(P<0.05)。GAND评分预估病人预后不良的曲线下面积(AUC)为0.855[95%CI(0.811,0.892),P<0.001],大于ASTRAL评分(AUC=0.848)、IScore评分(AUC=0.810),但差异无统计学意义(P>0.05)。结论:GAND评分操作简便,能早期、准确评估AIS病人短期预后。

Objective:To explore a simple,early and accurate prognostic tool for patients with acute ischemic stroke(AIS).Methods:Patients with AIS were included.The basic data and laboratory data of patients admitted to emergency hospital were collected.Based on the data collected,the National Institutes of Health Stroke Scale(NIHSS)score,Lausanne Acute Stroke Registry Scale(ASTRAL)score,and Ischemic Stroke Risk Prediction Score(IScore)at emergency admission were calculated.The modified Rankin Scale(mRS)score was used to evaluate the neurological function of the patients at 3 months after discharge.Logistic analysis was used to screen the indicators affecting the poor prognosis of patients,and glucose-atrial fibrillation-neutrophil-lymphocyte ratio-D-dimer(GAND)score was constructed.Receiver operating characteristic curve(ROC)was used to compare the efficacy of GAND score,ASTRAL score,and IScore score in predicting the prognosis of AIS patients.Results:A total of 312 patients with AIS were included in this study.Logistic regression analysis showed that atrial fibrillation history,systolic blood pressure(SBP)at admission,blood glucose(Glu),neutrophil count to lymphocyte count ratio(NLR),D-dimer(D-dimer)were independent risk factors for prognosis(P<0.05).The the area under the curve(AUC)of GAND score in predicting poor prognosis was 0.855[95%CI(0.811,0.892),P<0.001],it is higher than ASTRAL score(AUC=0.848)and IScore score(AUC=0.810),but the difference was not statistically significant(P>0.05).Conclusion:GAND score is a simple and accurate method to evaluate short-term prognosis of patients with AIS.