| Background and objectivesAcute ischemic stroke(AIS)is the most common type of stroke in China,accounting for 69.6%to 70.8%of stroke cases in China.AIS is usually caused by atherosclerotic stenosis,thrombosis,or embolic obstruction.It has the characteristics of high incidence,high mortality and high recurrence rate,which requires early intervention.Recently,endovascular treatment(EVT)has become the standard treatment for patients with AIS in anterior circulation with significant clinical benefits.However,successful intravascular reperfusion does not guarantee the good prognosis in AIS patients,and the overall probability of comorbidities and ineffectiveness after EVT remains relatively high.In view of this,it is of great importance to early identify the risk factors of poor prognosis of AIS patients undergoing EVT and give timely intervention.Previous studies have shown that high systolic blood pressure before EVT and high systolic blood pressure within 24 hours after successful reperfusion in EVT were associated with poor prognosis,suggesting that timely blood pressure management and corrective treatment are needed before and after EVT,but the control and management of blood pressure during EVT is not clear.This study included patients with AIS in anterior circulation who underwent EVT and successful reperfusion in our hospital,screened out the risk factors of short-term poor prognosis after successful reperfusion.Based on this,a prediction model was established,and the prediction ability of the model was evaluated.The aim of which is to help clinicians identify early patients who need active treatment and frequent follow-up,improve the therapeutic effect of EVT,improve the prognosis of patients,and reduce the burden of disease.MethodsThis study collected the clinical data of 363 patients with anterior circulation AIS who were hospitalized in the department of neurology of our hospital from September 2018 to September 2020 and met the exclusion criteria for this study.Using simple random sampling,Data from 70%of patients were collected as training set to develop a model for predicting the short-term prognosis of AIS patients in the anterior circulation,and the 30%of patients were collected as validation set to evaluate the predictive efficiency.According to the prognosis,the patients were divided into two groups:good prognosis group and poor prognosis group.The independent predictors were determined by univariate analysis and multivariate Logistic regression analysis.The receiver operating characteristic curve(ROC)was used to evaluate the performance of the model,and the paired chi-square test was used for internal verification.Results1.General Information:A total of 363 patients with anterior circulation AIS were included in this study,including 232 males(63.91%)and 131 females(36.09%),including 255 patients in the training set and 108 patients in the verification set.There was no significant difference in baseline characteristics between the training set and the verification set.There were 161 males(63.14%)and 94 females(36.86%)with a mean age of 60.20±10.93years.There were 143 patients with good prognosis,including 92 males(64.34%)and 51 females(34.66%)with a mean age of 58.99±10.87years.112 patients with poor prognosis included 69 males(61.61%)and 43 females(38.39%),with a mean age of 61.73±10.85 years.2.Analysis of risk factors of AIS:It was found that after testing the clinical data of the group with good prognosis and the group with poor prognosis,Age,stroke severity,coma degree,systolic blood pressure,diastolic blood pressure,mean arterial pressure,atrial fibrillation,cardiogenic embolism,blood glucose,neutrophils,infarction volume,NIHSS-ORT,intraoperative hypotension,intraoperative mean arterial pressure decreased more than 40%from baseline and treatment may be risk factors for poor prognosis of anterior circulation AIS(P<0.05).The above factors were included in multivariate logistic stepwise regression analysis.The results showed that blood glucose(P=0.009,OR=1.187),infarct volume(P=0.036,OR=1.147),NIHSS-ORT(P<0.001,OR=1.013),intraoperative hypotension(P=0.002,OR=2.925)and intraoperative mean arterial pressure decreased more than 40%(P<0.001,OR=7.463)were independent risk factors for anterior circulation AIS.3.Establishment and test of prediction model:The ROC curve was constructed by the logistic regression model of risk factors in the training set,including combined factors(AUC=0.806),blood glucose(AUC=0.597),infarct volume(AUC=0.662)and NIHSS-ORT(AUC=0.650).By Delong test,compared with combined prediction,blood glucose(Z=5.111,P<0.001),infarct volume(Z=4.026,P<0.001)and NIHSS-ORT(Z=4.797,P<0.001)predictive ability were lower,the difference was statistically significant.4.Prediction and test of verification set:According to the training set model,the verification set was predicted,and the paired chi-square test was carried out between the actual prognosis and the predicted prognosis.The results showed that there was no significant difference between the two groups(P=0.564).Conclusions1.Blood glucose,infarct volume,NIHSS-ORT,mean arterial pressure decreased by more than 40%compared with baseline,and intraoperative hypotension were independent predictors of poor short-term prognosis in patients with anterior circulation AIS after EVT.2.The combined prediction model was established and verified,the AUC was 0.806,the sensitivity was 0.732,and the specificity was 0.811.There was no significant difference between the actual prognostic results and the predicted prognostic results.3.This model has a good predictive ability and is helpful for clinicians to identify anterior circulation AIS patients with high risk of poor prognosis and improve the prognosis of EVT. |
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