A nomogram predicts short-term outcome in patients with acute cardioembolic stroke due to nonvalvular atrial fibrillation
10.3760/cma.j.issn.1673-4165.2024.10.002
- VernacularTitle:列线图预测非瓣膜性心房颤动所致急性心源性栓塞性卒中患者短期转归
- Author:
Jie HU
1
;
Long WANG
;
Xinyi CHEN
;
Xun HE
;
Juncang WU
Author Information
1. 安徽医科大学附属合肥医院（合肥市第二人民医院）神经内科，合肥 230011
- Keywords:
Embolic stroke;
Atrial fibrillation;
Treatment outcome;
Risk factors;
Biomarkers;
Nomograms;
Predictive value of tests
- From:
International Journal of Cerebrovascular Diseases
2024;32(10):728-734
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To develop and validate a nomogram model for predicting short-term outcome in patients with acute cardioembolic stroke (CES) due to nonvalvular atrial fibrillation (NVAF).Methods:Patients CES due to NVAF who were hospitalized in the Department of Neurology of Hefei Second People's Hospital from January 2023 to August 2024 were retrospectively included. The modified Rankin Scale was used to evaluate outcome at the 14 th day after discharge or onset. A score ≤2 was defined as good outcome, and a score >2 was defined as poor outcome. The demographic data, National Institutes of Health Stroke Scale (NIHSS) scores at admission, and laboratory tests within 24 hours of admission were collected, and the neutrophil/lymphocyte ratio (NLR) and stress hyperglycemia ratio (SHR) were calculated. Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcome, the nomogram prediction model was developed based on these risk factors, and the internal data was used to validate the predictive performance of the model. Results:A total of 196 patients with CES due to NVAF were enrolled, including 109 females (55.61%), median aged 80 years (interquartile range: 73-84 years). Ninety patients (50.00%) had good outcome, 98 (50.00%) had poor outcome, and 11 (5.61%) died. Multivariate logistic regression analysis showed that higher baseline NIHSS scores (odds ratio [ OR] 1.088, 95% confidence interval [ CI] 1.023-1.157; P=0.007), NLR ( OR 1.279, 95% CI 1.111-1.472; P<0.001), and female gender ( OR 2.288, 95% CI 1.017-5.149; P=0.045) were the independent risk factors for poor short-term outcome. The above variables were included to develop a nomogram prediction model. The internal validation showed that the C-statistic was 0.820 (95% CI 0.761-0.879), indicating good discriminability. In the calibration curve, both the actual curve and the deviation calibration curve tended to approach the ideal curve. Decision curve analysis showed that the model predicted a risk threshold for CES due to NVAF between 0.10-0.30 and 0.33-0.89, which could provide clinical benefits. Conclusions:Baseline NIHSS score, NLR, and gender are the independent risk factors for poor short-term outcome in patients CES due to NVAF. Higher baseline NIHSS score, NLR, and female gender suggest poor short-term outcome. The nomogram developed based on these factors shows good predictive power for poor short-term outcome.
