Construction of Predictive Model of 1-year Stroke Recurrence for Stroke Patients in Xi'an

doi:10.3969/j.issn.1673-5765.2020.01.005

Abstract

Abstract:

Objective To construct a predictive model of 1-year stroke recurrence for stroke patients in Xi'an. Methods Data of acute stroke patients from Xi'an Stroke Database from January 1 to December 31, 2016 were collected. Clinical data included in-hospital data and the follow-up results at 1 year after discharge. After analyzing the risk factors affecting recurrent stroke, a predictive model of 1-year stroke recurrence was constructed using the Cox proportional hazard regression model. Results A total of 2775 patients with acute stroke were enrolled in this study. Recurrent stroke ocurred in 144 patients (accumulated risk 5.34%) within 1 year. A predictive model for the 1-year stroke recurrence as follows: h (t ) = h0 exp (0.02900×age + 0.83649×prior stroke + 0.26683×peripheral vascular disease history + 0.12887×NIHSS score at admission). The area under the ROC curve was 0.82, the best cut-off point was 0.197, the sensitivity and specificity were 0.69 and 0.78, respectively. The total accuracy of the predictive model is 83%. Conclusions The 1-year stroke recurrence predictive model for stroke patients in Xi'an is targeted, simple, practical and easy to operate. The high-risk stroke patients in Xi'an can be identified by the predictive model and are given individualized treatment timely, which will reduce the recurrence rate of stroke and improve the prognosis of stroke patients.

Key words: Stroke; Recurrence; Prediction; Model

摘要：

目的构建西安地区卒中患者1年卒中复发的预测模型。方法以西安市卒中数据库2016年1月1日-12月31日的急性卒中患者作为研究对象，收集患者的临床资料，并在出院后1年时进行随访。应用Cox比例风险回归模型对影响患者卒中复发的危险因素进行单因素和多因素分析，并应用逐步回归前进法构建卒中1年复发的预测模型。结果研究共纳入2775例急性卒中患者，一年随访结束时，累计复发144例，累计复发率为5.34%。对与卒中复发有关的变量进行分析后，建立卒中1年复发的预测模型：h（t）=h0 exp（0.02900×年龄 +0.83649×既往卒中+0.26683×周围血管病+0.12887×入院NIHSS评分）。模型ROC曲线下的面积为 0.82，最佳截断值为0.197，敏感度及特异度分别为0.69和0.78，总的准确度为83%。结论本研究构建的西安地区卒中患者1年复发预测模型针对性强，简单实用，易于操作。通过预测模型可以早期识别西安地区卒中高危患者并进行个体化治疗，从而降低本地区卒中复发率，改善患者预后。

关键词: 卒中; 复发; 预测; 模型

LIN Xue-Mei, WANG Fang, WANG Jing, CAO Huan, LU Qing-Li, LIU Zhong-Zhong, DUAN Kang-Li, WU Song-Di. Construction of Predictive Model of 1-year Stroke Recurrence for Stroke Patients in Xi'an[J]. Chinese Journal of Stroke, 2020, 15(01): 33-39.

蔺雪梅，王芳，王静，曹欢，逯青丽，刘仲仲，段康丽，吴松笛. 西安地区卒中患者1年卒中复发预测模型的构建[J]. 中国卒中杂志, 2020, 15(01): 33-39.

References

[1] FEIGIN V L，NORRVING B，MENSAH G A.

Global burden of stroke[J]. Circ Res，2017，120（3）：

439-448.

[2] 王陇德，刘建民，杨弋，等. 《中国脑卒中防治报告

2017》概要[J]. 中国脑血管病杂志，2018，15（11）：

611-617.

[3] 邹芳，田晔，吴卫国，等. 基于非结构化电子病历的脑卒中数据挖掘管理系统设计和实现[J]. 中国数字

医学，2015，10（3）：41-44.

[4] ASPLUND K，TUOMILEHTO J，STEGMAYR

B，et al. Diagnostic criteria and quality control of

the registration of stroke events in the MONICA

project[J]. Acta Med Scand Suppl，1988，728：26-39.

[5] WANG Y，ZHAO X，LIU L，et al. Prevalence and

outcomes of symptomatic intracranial large artery

stenoses and occlusions in China：the Chinese

Intracranial Atherosclerosis（CICAS）study[J].

Stroke，2014，45（3）：663-669.

[6] LOVETT J K，COULL A J，ROTHWELL P M.

Early risk of recurrence by subtype of ischemic

stroke in population-based incidence studies[J].

Neurology，2004，62（4）：569-573.

[7] HANKEY G J. Secondary stroke prevention[J]. The

Lancet Neurol，2014，13（2）：178-194.

[8] KRISHNAMURTHI R，WITT E，BARKERCOLLO

S，et al. Reducing recurrent stroke：

methodology of the motivational interviewing in

stroke（MIST）randomized clinical trial[J]. Int J

Stroke，2014，9（1）：133-139.

[9] SONG B，WANG Y，ZHAO X，et al. Inpatient statin

use is associated with decreased mortality of acute

stroke patients with very low low-density lipoprotein

cholesterol[J]. J Stroke Cerebrovasc Dis，2015，24

（10）：2369-2374.

[10] TAN Y，PAN Y，LIU L，et al. One-year outcomes

and secondary prevention in patients after acute

minor stroke：results from the China National Stroke

Registry[J]. Neurol Res，2017，39（6）：484-491.

[11] 蒋瑞姝，易坤昌，郑文富. 脑卒中复发的影响因素分

析[J]. 慢性病学杂志，2017，18（8）：889-890.

[12] CALLALY E，NI CHROININ D，HANNON N，et

al. Rates，predictors，and outcomes of early and

late recurrence after stroke：The North Dublin

Population Stroke Study[J]. Stroke，2016，47（1）：

244-246.

[13] FENG W，HENDRY R M，ADAMS R J. Risk of

recurrent stroke，myocardial infarction，or death in

hospitalized stroke patients[J]. Neurology，2010，74

（7）：588-593.

[14] MOHAN K M，CRICHTON S L，GRIEVE A P，et

al. Frequency and predictors for the risk of stroke

recurrence up to 10 years after stroke：the South

London Stroke Register[J]. J Neurol Neurosurg

Psychiatry，2009，80（9）：1012-1018.

[15] LEE B I，NAM H S，HEO J H，et al. Yonsei Stroke

Registry. Analysis of 1000 patients with acute

cerebral infarctions[J]. Cerebrovasc Dis，2001，12

（3）：145-151.

[16] SARTOR E A，ALBRIGHT K，BOEHME A K，et

al. The NIHSS Score and its components can predict

cortical stroke[J]. J Neurol Disord，2013，2（1）：

1026.

[17] 段佳，黄伟，罗可. 某医院脑卒中患者照顾者疾病相

关知识认知情况调查[J]. 解放军预防医学杂志，2017，

35（10）：1304-1306.

[18] ARSAVA E M，KIM G M，OLIVEIRA-FILHO

J，et al. Prediction of early recurrence after acute

ischemic stroke[J]. JAMA Neurol，2016，73（4）：

396-401.

[19] MAIER I L，BAUERLE M，KERMER P，et al.

Risk prediction of very early recurrence，death and

progression after acute ischaemic stroke[J]. Eur J

Neurol，2013，20（4）：599-604.

[20] 安雅臣，王玉浔，张江，等. 缺血性脑卒中复发预测

模型的构建[J]. 中国康复理论与实践，2013，29（3）：

210-213.

[21] 谭英，耿德勤，黄水平. 用人工神经网络建立缺血性

脑卒中复发的预测模型[J]. 中国卫生统计，2013，30

（5）：687-689.