Construction of a Nomogram to predict the risk of ineffective rehabilitation of acute ischemic stroke and its verification
Objective To construct a nomogram to predict the risk of ineffective rehabilitation of acute ischemic stroke and to validate its performance.Methods The clinical data of 396 patients with acute ischemic stroke admitted to Zhengzhou Cigarette Factory Rehabilitation Hospital from October 2018 to October 2022 were retrospectively analyzed.They were randomly divided into modeling group(264 cases) and verification group(132 cases) according to a ratio of 2:1.According to the rehabilitation of patients in the modeling group 3 months after treatment,they were further divided into ineffective group(63 cases) and effective group(201 cases).Multivariate Logistic regression analysis was used to analyze the risk factors of ineffective rehabilitation of acute ischemic stroke. The R 3.4.3 software package was used to construct a Nomogram to predict the risk of ineffective rehabilitation of acute ischemic stroke and its internal verification was performed by the Bootstrap method.The calibration curve was drawn to evaluate the calibration of the Nomogram,and the receiver operating characteristic(ROC) curve was drawn to evaluate the predictive efficacy of the Nomogram.The decision curve(DCA) was used to verify the clinical net benefit rate of the nomogram.Results In the modeling groups,history of atrial fibrillation,maximum diameter of infarction>4 cm,disturbance of consciousness,proportion of hemorrhagic transformation,the National Institutes of Health stroke scale(NIHSS) score,blood glucose level,glycosylated hemoglobin level and D-dimer(D-D) level in the ineffective group were significantly higher than those in the effective group(P<0.05),and the time from onset to thrombolysis was significantly longer than that in the effective group(P<0.05). Multivariate Logistic regression analysis showed that atrial fibrillation,long time from onset to thrombolysis,elevated NIHSS score,maximum diameter of infarction>4 cm,hemorrhagic transformation,elevated blood glucose level and elevated D-D level were all risk factors for ineffective rehabilitation in patients with acute ischemic stroke(P<0.05).The Nomogram constructed based on the above influencing factors was verified by Bootstrap method.The consistency index of the modeling group and the verification group was 0.830 and 0.816,respectively.The calibration curve was in good agreement with the standard curve.The ROC curve results showed that the area under the curve of the Nomogram to predict ineffective rehabilitation in acute ischemic stroke patients in the modeling group and the verification group was 0.873 and 0.856,respectively.The DCA curve showed that the risk threshold probability of the modeling group and the verification group had a higher net benefit value at 2％-99％ and 9％-90％,respectively.Conclusion Atrial fibrillation,long time from onset to thrombolysis,elevated NIHSS score,maximum diameter of infarction>4 cm,hemorrhagic transformation,elevated blood glucose level and elevated D-D level are all risk factors for ineffective rehabilitation in patients with acute ischemic stroke.The Nomogram constructed accordingly has good clinical application value.
万方数据
维普
