Establishment and Verification of Nomogram of Early Neurological Deterioration in Patients with Acute Penetrating Artery Infarction
Objective To investigate the risk factors for early neurological deterioration(END)in patients with acute penetrating artery infarction(PAI)and to develop and evaluate a nomogram model.Methods Patients with acute cerebral infarction of lateral lenticulostriate artery and paramedian pontine artery in Puyang people's hospital from January 2021 to February 2023 were retrospectively included.Patients with NIHSS score increased by≥2 points within 5 days after admission were included in the END group.Patients with NIHSS score increased by≤2 points within 5 days after admission were included in the non-END group.The data set was randomly divided into a training set and a test set according to the ratio of 7∶3,and the test set was used to evaluate the model performance.In the training set,univariate analysis was performed with R software,and for variables with P<0.10,least absolute shrinkage and selection operator(LASSO)regression and logistic regression analysis were used to screen out the independent risk factors for the occurrence of END in PAI patients,and finally a nomogram prediction model was constructed.The ROC curve and AUC were used to evaluate the discrimination of the model for the training set and the test set,respectively.Decision curve analysis(DCA)was used to evaluate the clinical utility of the model,and calibration chart was used to evaluate the accuracy of the model.Results A total of 400 patients with acute cerebral infarction of lateral lenticulostriate artery and paramedian pontine artery were included,including 261 males(65.25%).The median age was 64(56-70)years.There were 135 cases(33.75%)in the END group and 265 cases(66.25%)in the non-end group.Of 280 acute PAI patients in the training set,94 cases(33.57%)had END.Of 120 patients in the test set,41 cases(34.17%)had END.In the training set,11 variables(P<0.10)were entered into LASSO regression and 5 variables were screened out:diastolic blood pressure at admission,history of diabetes,history of smoking,neutrophil to lymphocyte ratio(NLR),maximum diameter.Multivariate logistic regression analysis showed that NLR(OR40.85,95%CI13.34-196.43,P<0.01),history of diabetes(OR24.10,95%CI6.92-106.30,P<0.01),history of smoking(OR6.16,95%CI1.54-28.39,P=0.01)and maximum diameter(OR4.93,95%CI1.35-19.82,P=0.02)are independent risk factors for the occurrence of END in acute PAI patients,and they are included in the nomogram.Bootstrap method was used for internal verification,and ROC curve,calibration curve and DCA curve of training set and test set were drawn respectively.The AUC of ROC of the training set and the test set were 0.88 and 0.87,respectively.The predicted value of calibration chart is in good agreement with the actual value,and the DCA curve shows that the prediction model has high clinical practicability.Conclusions NLR,history of smoking,history of diabetes and maximum diameter are independent risk factors for the occurrence of END in acute PAI patients,and the nomogram prediction model has certain clinical practical value.
万方数据
维普
