INR联合APACHEⅣ评分对出血性脑卒中病人预后的预测价值

Predictive value of INR combined with APACHEⅣscore in the prognosis of patients with hemorrhagic stroke

目的:探讨INR联合APACHEⅣ评分对出血性脑卒中病人预后的预测价值。方法:选取美国多中心急诊重症监护病(eICU)数据库中首要诊断为出血性脑卒中的1026例病人为研究对象,应用单因素和多因素Logistic回归分析对影响病人医院死亡率的危险因素进行分析并建立预测模型。结果:多因素Logistic回归分析结果显示,急性生理与慢性健康状况评分系统Ⅳ(APACHEⅣ评分)、国际标准化比值(INR)为出血性脑卒中病人医院死亡的独立危险因素;抗凝治疗为出血性脑卒中病人医院死亡的保护性因素。APACHEⅣ评分联合INR预测出血性脑卒中病人医院死亡率的受试者工作特征(ROC)曲线下面积为0.795[95%CI(0.760,0.831)],最佳截断值为0.210,灵敏度为78.9%,特异度为70.1%。结论:APACHEⅣ评分联合INR对出血性脑卒中预后具有较好的预测价值。

Objective:To explore the predictive value of INR combined APACHEⅣscore in the prognosis of patients with hemorrhagic stroke.Methods:A total of 1026 patients with a primary diagnosis of hemorrhagic stroke from a national multicenter cohort study(eICU database)were enrolled.Univariate and multivariate analysis of the risk factors affecting hospital mortality was performed using a binary logistic regression model and a predictive model was established.Results:Multivariate logistic regression analysis showed that APACHEⅣand INR were independent risk factors for hospital mortality in hemorrhagic stroke patients.Anticoagulant therapy was a protective factor for hospital mortality in patients with hemorrhagic stroke.According to the APACHEⅣscore and INR,the prediction model was established.The area under the ROC curve was 0.795(95%CI 0.760⁃0.831).The best cut-off value was 0.210,the sensitivity was 78.9%,and the specificity was 70.1%.Conclusion:APACHEⅣscore combined with INR has certain predictive value for the prognosis of hem⁃orrhagic stroke patients.