AIS患者血管内机械取栓成功再通后预后不良风险预测模型的构建

Establishment of a risk prediction nomogram for poor prognosis of patients with acute ischemic stroke after successful re-canalization of endovascular mechanical thrombectomy

目的构建急性缺血性卒中(AIS)患者血管内机械取栓(EMT)成功再通后预后不良风险预测模型。方法回顾性选取2019年1月至2022年12月在江苏大学附属人民医院行EMT后血管再通成功的128例AIS患者为研究对象,比较预后良好组与预后不良组临床资料,采用多因素logistic回归分析AIS患者EMT成功再通后90 d预后不良的影响因素,构建AIS患者EMT成功再通后90 d预后不良风险预测模型,采用ROC曲线、Hosmer-Lemeshow检验、校准曲线分析模型的预测效能。结果AIS患者EMT成功再通后90 d预后良好61例,预后不良67例。入院时美国国立卫生研究院卒中量表(NIHSS)评分(OR=0.150)、串联病变(OR=0.125)、改良脑梗死溶栓(mTICI)分级(OR=54.560)、术后症状性颅内出血(sICH)(OR=0.103)、血糖(OR=1.377)、舒张压(OR=1.044)是AIS患者EMT成功再通后90 d预后不良的独立影响因素(均P<0.05)。基于上述6个独立影响因素构建AIS患者EMT成功再通后90 d预后不良风险预测模型。该模型预测预后不良的AUC为0.894(95%CI:0.836~0.952);预测预后不良发生率与实际预后不良发生率比较,差异无统计学意义(P=0.765);校正曲线与理想曲线拟合良好,绝对误差为0.031。结论基于入院时NIHSS评分、串联病变、mTICI分级、术后sICH、血糖、舒张压构建的预测模型对AIS患者EMT成功再通后90 d预后不良风险预测效果良好,可为临床提供参考。

Objective To analyze the prognostic factors influencing the prognosis of patients with acute ischemic stroke(AIS)after vascular recanalization by endovascular mechanical thrombectomy(EMT)to construct a nomogram model.Methods AIS patients with successful vascular recanalization after EMT at the Affiliated People's Hospital of Jiangsu University,from January 2019 to December 2022 were enrolled.The clinical data of the good prognosis group and the poor prognosis group was compared.Factors influencing patients'prognosis at 90 d postoperatively were analyzed using univariate and multivariate logistic regression to construct a nomogram model.ROC curve,Hosmer-Lemeshow test and calibration curve were used to analyze the predictive efficiency of the model.Results At 90 d after successful recanalization by EMT,61 patients had good prognosis and 67 patients had poor prognosis.National Institutes of Health Stroke Scale(NIHSS)score(OR=0.150)at admission,tandem lesion(OR=0.125),modified Thrombolysis In Cerebral Infarction(mTICI)grade(OR=54.560),postoperative symptomatic intracranial hemorrhage(sICH)(OR=0.103),and baseline blood glucose(OR=1.377)and diastolic blood pressure(OR=1.044)were independent influencing factors on the poor prognosis of patients at 90 d after successful recanalization by EMT(all P<0.05).The above six independent risk factors were used to construct the nomogram model,which had an AUC of 0.894(95%CI:0.836-0.952),and there was no significant difference between predicted and actual incidence of poor prognosis(P=0.765).The calibration curve fits well with the ideal curve with an absolute error of 0.031.Conclusion The prediction model established based on NIHSS score at admission,mTICI grade,tandem lesions,postoperative sICH,blood glucose,and diastolic blood pressure showed good performance in predicting poor prognosis of AIS patients with successful recanalization after EMT,providing reference for clinical practice.