Model construction and evaluation of early neurological deterioration in acute ischemic stroke / 中国实用护理杂志

ABSTRACT

Objective:To construct a model of early neurological deterioration (END) in acute ischemic stroke (AIS), and to evaluate the predictive value of this model.Methods:From February 2018 to December 2020, 263 cases of AIS patients admitted to Response General Hospital were selected as research objects. According to whether END occurs, they were divided into END group (80 cases) and non-END group (183 cases). Logistic regression was used to analyze the independent risk factors of AIS concurrent END, and the predictive model of the above factors was constructed. The value of the model was evaluated by receiver operating characteristic (ROC) curve, correction curve and decision curve analysis (DCA).Results:Systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, National Institutes of Health Stroke Scale (NIHSS) and door to needle time (DNT) in the END group were (144.66 ± 18.08) mmHg(1 mmHg=0.133 kPa), (84.04 ± 8.47) mmHg, (6.15 ± 1.00) mmol/L, (4.82 ± 1.08) mmol/L, (14.90 ± 4.95) points, (4.58 ± 1.02) h, all higher than those in the non-END group (132.32 ± 15.53) mmHg, (81.19 ± 11.00) mmHg, (5.53 ± 0.98) mmol/L, (4.51 ± 1.15) mmol/L, (11.37 ± 3.32) points, (3.22 ± 1.08) h, and the level of high density lipoprotein cholesterol was (1.09 ± 0.07) mmol/L in the END group,lower than that in the non-END group (1.15 ± 0.08) mmol/L, the differences were statistically significant ( t values were 2.07-9.53, all P<0.05). Logistic regression analysis showed that fasting plasma glucose ( OR=2.25, 95% CI 1.50-3.40, P<0.05), systolic blood pressure ( OR=1.04, 95% CI 1.02-1.07, P<0.05), NIHSS score ( OR=1.26, 95% CI 1.14-1.39, P<0.05) and DNT ( OR=3.44, 95% CI 2.30-5.14, P<0.05) were independent risk factors for AIS concurrent END. The area under ROC curve, sensitivity and specificity of the model X composed of fasting plasma glucose, systolic blood pressure, NIHSS scores and DNT for diagnosing AIS concurrent END were 0.90 (95% CI 0.87-0.94), 90.00% and 77.60% respectively. The calibration curve of model X had a high coincidence with the ideal curve. Conclusions:The model X composed of fasting plasma glucose, systolic blood pressure, NIHSS score and DNT has high application value for the prediction of END, which can assist the clinic to make better decision.