A study on development and evaluation of a nomogram prediction model of cystatin C for the patients with stroke of large-artery atherosclerosis / 中风与神经疾病杂志

ABSTRACT

@#Objective To establish a nomogram model based on cystatin C (Cys-C) to predict the risk of large-artery atherosclerosis (LAA) by analyzing the risk factors of LAA and to evaluate its effectiveness. Methods A retrospective observational study performed on clinical data of 800 patients with acute ischemic stroke (AIS) in the Department of Neurology,Affiliated Hospital of Xuzhou Medical University,from January 2019 to January 2022.Patients were randomly assigned (2∶1 ratio) to the training set (n=546) and the validation set (n=254). The independent risk factors of LAA were determined by logistic regression analysis. A nomogram model of the risk of LAA was established and the model was verified internally and externally. The nomogram was evaluated based on discrimination,calibration,and clinical efficacy using the concordance statistic (C-statistic),calibration plot and decision curve analysis (DCA),respectively. Results Univariate and multifactor logistic regression analysis screening showed hypertension,diabetes,cystatin c,low-density lipoprotein (LDL),homocysteine (HCY),and hypersensitive C-reactive protein (hs-CRP) as independent correlated predictors of LAA,and the prediction model constructed from this,and the ROC curve was plotted with an area under the training set curve of 0.800 (0.762-0.838),with a diagnostic threshold of 0.6224,corresponding to a sensitivity of 68.3% and a specificity of 79.2%,and a validation set curve with an area under the curve of 0.838 (0.786-0.890) and a diagnostic threshold of 0.5901,corresponding to a sensitivity of 79.5% and a specificity of 78.5%,with a well-fitted calibration curve. Conclusion The nomogram model established has a good degree of differentiation and accuracy. It has a good performance in predictive ability,which is simple,intuitive and individualized to screen high-risk groups and has a certain predictive value for the occurrence of LAA patients,and can improve their prognosis through various preventive measures at an early stage.