Influencing factors and prediction analysis of acute ischemic stroke after surgery
Objective To explore the influencing factors and establish a prediction model of acute ischemic stroke(AIS)in patients in intensive care unit(ICU)within 30 d after surgery.Methods A total of 5 180 patients with non-neurological and non-cardiac macrovascular sugery admitted to the Surgical Intensive Care Unit of Beijing Chaoyang Hospital,Capital Medical University from July 2018 to March 2023 were selected by a nested case-control study method,and a cohort was established and baseline data was collected to analyze the accurence of AIS within 30 d after surgery.After 30 days of follow-up,patients with newly diagnosed AIS within 30 d after surgery were selected as the case group,the survivors who did not have AIS within 30 d after surgery were selected as the control group based on gender,age and type of surgery according to the matching method of 1∶4 between the case group and the control group.Multivariate conditional logistic regression equation was used to analyze the influencing factors of AIS within 30 d,and a risk prediction model was established.Results Among the 5 180 patients,41 patients developed AIS within 30 d after surgery,and the incidence rate was 0.79%.A total of 164 patients in the control group were matched.Multivariate regression analysis results showed that previous history of cerebrovascular disease(OR=5.003,95%CI:1.586-15.783,P=0.006),severe intraoperative hypotension(OR=30.104,95%CI:3.609-251.110,P=0.002),increasement of blood lactic acid level within 24 h after surgery(OR=1.724,95%CI:1.071-2.776,P=0.025)and increasement of FIB level within 24 h after surgery(OR=1.009,95%CI:1.001-1.016,P=0.019)were risk factors of postoperative AIS in surgical patients within 30 d.A predictive model was established based on the four risk factors,with the AUC of ROC curve 0.922(95%CI:0.863-0.982,P＜0.001).Conclusions The prediction model and the nomogram can quantify the risk of AIS according to the risk factors for AIS within 30 d.For non-neurological and non-cardiac macrovascular sugery postoperative patients,it is necessary to carefully inquire about their history of cerebrovascular disease and intraoperative conditions,closely monitor the levels of blood lactic acid and FIB,and be alert to the occurrence of AIS after surgery.
postoperativeacute ischemic stroke(AIS)risk factorpredictive modelnomogramintensive care unit(ICU)
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万方数据
