基于炎症及营养指标构建老年急性缺血性脑卒中预后模型

doi:10.16460/j.issn1008-9969.2023.11.001

摘要/Abstract

摘要： 目的应用炎症及营养指标构建老年急性缺血性脑卒中预后的预测模型并验证。方法将2021年11月—2022年5月唐山市某三级甲等医院586例老年急性缺血性脑卒中患者分为预后良好组（n=438）和预后不良组（n=148）。以LASSO回归与二元Logistic回归分析危险因素,建立列线图模型并验证。结果多因素分析结果显示高龄、合并慢性病、同型半胱氨酸>15 mmol/L、淋巴细胞与单核细胞比值<3.713、白蛋白与球蛋白比值<1.527、老年营养风险指数<99.837是老年急性缺血性脑卒中患者预后不良的危险因素。列线图模型AUC=0.774（95%CI:0.730~0.818）;Bootstrap内部验证法其真实值与预测值符合度的平均绝对误差为0.011;Brier得分为0.152;H-L检验P=0.733;决策曲线显示高风险概率值为0.03~0.65。结论应用炎症及营养指标构建的列线图模型作为预测老年急性缺血性脑卒中预后不良的工具有较高的应用价值。

关键词: 缺血性卒中, 炎症, 营养评价, 模型, 统计学

Abstract: Objective To construct and validate a predictive model for the prognosis of acute ischemic stroke in the elderly based on inflammatory and nutritional indicators. Methods A total of 586 elderly patients with acute ischemic stroke from November 2021 to May 2022 in a tertiary grade-A hospital in Tangshan City were divided into good prognosis group (n=438) and poor prognosis group (n=148). Risk factors were analyzed by LASSO regression with binary logistic regression, and a nomogram was developed and validated. Results Multifactorial analysis showed that advanced age, concurrent chronic diseases, homocysteine >15 mmol/L, lymphocyte to monocyte ratio <3.713, albumin to globulin ratio <1.527, and geriatric nutritional risk index <99.837 were risk factors for poor prognosis in elderly patients with acute ischemic stroke. AUC of the nomogram was 0.774 (95%CI:0.730~0.818); mean absolute error of conformity between the true and predicted value was 0.011 by bootstrap internal validation method; Brier score was 0.152; Hosmer-Lemeshow test P=0.733, and decision curve showed high risk probability value ranged between 0.03 and 0.65. Conclusion The constructed nomogram based on inflammatory and nutritional indicators have high application value and could be used as a tool to predict the poor prognosis of acute ischemic stroke in the elderly.

Key words: ischemic stroke, inflammation, nutrition assessment, model, statistics

中图分类号:

R743

赵旭, 赵雅宁, 李建民, 刘瑶, 赵大业, 陈长香. 基于炎症及营养指标构建老年急性缺血性脑卒中预后模型[J]. 护理学报, 2023, 30(11): 1-6.

ZHAO Xu, ZHAO Ya-ning, LI Jian-min, LIU Yao, ZHAO Da-ye, CHEN Chang-xiang. Construction of prognostic model of acute ischemic stroke in elderly individuals based on inflammatory and nutritional indicators[J]. Journal of Nursing, 2023, 30(11): 1-6.

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