老年急性缺血性脑卒中患者预后因子筛选及列线图模型构建

Screening of prognostic factors and construction of a nomogram model for elderly patients with acute cerebral ischemic stroke

目的探索老年急性缺血性脑卒中(acute cerebral ischemic stroke,ACIS)患者预后不良危险因素,构建危险评分计算公式,评估患者的预后。方法选取2021年1月—2022年3月在芜湖市第五人民医院治疗的123例老年ACIS患者的临床病历资料进行回顾性研究,设为预后不良组(n=64)和预后良好组(n=59)。筛选预后不良的独立危险因素,构建列线图模型,并通过校准曲线和受试者工作特征曲线评估模型的预测效能。结果年龄(OR=1.21,P=0.004)、体质量指数(BMI)值(OR=1.31,P=0.032)、血清C反应蛋白水平(OR=1.22,P=0.003)、血清D-二聚体水平(OR=1.99,P=0.006)、血清纤维蛋白原水平(OR=1.19,P=0.016)、NIHSS评分(OR=1.46,P=0.002)是老年ACIS者预后不良的危险因素;年龄(OR=1.13,P=0.042)、血清D-二聚体水平(OR=1.49,P=0.008)、NIHSS评分(OR=1.38,P=0.004)是老年ACIS患者预后不良的独立危险因素。年龄增加、血清D-二聚体水平和NIHSS评分升高均会导致老年ACIS患者预后不良风险增加。基于危险因素构建的列线图模型与理想曲线之间平均绝对误差=0.022,均方误差=0.00065;列线图模型的ROC曲线下面积为0.871。结论年龄、BMI、血清C反应蛋白水平、D-二聚体水平、纤维蛋白原水平、NIHSS评分是老年ACIS患者预后不良的危险因素,其中年龄、D-二聚体水平、NIHSS评分为独立危险因素。依据上述危险因素构建的列线图模型危险评分可能准确预测老年ACIS患者预后,具有较好的诊断效能;该项模型具有一定的临床应用价值,对ACIS的早期预测具有重要意义。

Objective To explore the risk factors for poor prognosis in elderly patients with acute cerebral ischemic stroke(ACIS),construct a risk score calculation formula and evaluate the prognosis of patients.Methods The clinical medical records of 123 elderly ACIS patients treated in Fifth People s Hospital of Wuhu City from January 2021 to March 2022 were retrospectively studied.They were divided into poor prognosis group(n=64)and good prognosis group(n=59).The independent risk factors for poor prognosis were screened and a nomogram model was constructed.The predictive performance of the model was evaluated by calibration curve and receiver operating characteristic curve(ROC).Results Age(OR=1.21,P=0.004),body mass index(BMI)value(OR=1.31,P=0.032),serum C-reactive protein level(OR=1.22,P=0.003),serum D-dimer level(OR=1.99,P=0.006),serum fibrinogen level(OR=1.19,P=0.016)and NIHSS score(OR=1.46,P=0.002)were risk factors for poor prognosis in elderly ACIS patients.Age(OR=1.13,P=0.042),serum D-dimer level(OR=1.49,P=0.008)and NIHSS score(OR=1.38,P=0.004)were independent risk factors for poor prognosis in elderly ACIS patients.Aging,elevated serum D-dimer level and elevated NIHSS score increased the risk of poor prognosis in elderly ACIS patients.The mean absolute error and mean square error between the nomogram model constructed based on risk factors and the ideal curve were 0.022 and 0.00065,respectively.The area under the ROC curve of the nomogram model was 0.871.Conclusion Age,BMI,serum C-reactive protein level,serum D-dimer level,serum fibrinogen level and NIHSS score are risk factors for poor prognosis in elderly ACIS patients,among which age,serum D-dimer level and NIHSS score are independent risk factors.The risk score of the nomogram model constructed based on the above risk factors may accurately predict the prognosis of elderly ACIS patients,and has a good diagnostic performance.This model has certain clinical application value and is of great significance for the early prediction of ACIS.