Establishment And Validation Of Predictive Model Of Acute Anterior Circulation Ischemic Stroke With Endovascular Treatment Prognosis

Objective:To investigate analysis of prognostic factors of acute anterior circulation ischemic stroke with endovascular treatment,and to establish a prediction model in combination with related prognostic variables.Methods:This study was designed as a prospective cohort study.258 Patients with acute anterior circulation ischemic stroke hospitalized in the department of neurology of the First People’s Hospital of Changde City from January 1st 2019 to November 31 th 2020 were selected.Total of 174 patients were included in the follow-up according to inclusion and exclusion criteria,and 155 patients were finally followed up,collecting the 155 patients who were acceped to endovascular treatment and registered the ordinal score on the modified Rankin scale(m RS)at day 90,with good outcomes at 90(m RS ≤ 2)and bad outcomes at 90(m RS 3-6).Analysis of influencing factors of acute anterior circulation ischemic stroke with endovascular treatment was analyzed by Logistic univariate(P<0.05),and multivariate analysis to get independent prognostic factors simultaneously weeding out mixed factors.About 70% of the 155 patients were randomly selected as the establishment model group(n=108),and about 30% were the verification group(n=47).The data from the model group were selected,and Logistic regression analysis was used to build a predictive model with prognostic factors.The validation group data were substituted into the predictive model,and the predictive value of the model was evaluated by ROC curve area(AUC),and the data is verified through 100 data resampling by Bootstrap method.SPSS 21.0 software was used for data analysis.Results:1.A total of 155 patients were followed up.There were67(43.22%)patients in the good outcomes group,and 88(56.77%)patients in the bad outcomes group.2.Logistic unifactorial analysis indicated that age,c-reactive protein,lymphocytes cell count,neutrophil granulocyte cell count,atrial fibrillation,and collateral circulation grade had statistically significant differences between the good outcome group and the bad outcome group(P<0.05).3.Logistic multivariate analysis indicated that the differences in lymphocytes cell count,collateral circulation grade,atrial fibrillation had statistically significant differences between the good outcome group and the bad outcome group(P<0.05).4.Logistic regression analysis indicated that lymphocytes cell count(OR=9.14,95%CI:2.84-36.68),collateral circulation grade(OR=4.22,95%CI:1.59-11.70),atrial fibrillation(OR=0.19,95%CI :0.06-0.49)all had good predictive value for acute anterior circulation ischemic stroke endovascular treatment function recovering at 90 days.A predictive model was established according to the results of Logistic regression analysis.The area under the ROC curve of the establiashment predictive model was 0.779(95%CI:0.728-0.888)through 100 data resampling,and the validation group was 0.803(95%CI:0.658-0.948)through 100 data resampling,indicating that the predictive model had some predictive value.Conclusion:The prognosis of acute anterior circulation ischemic stroke with endovascular treatment may be associated with lymphocytes cell count,collateral circulation grade,atrial fibrillation.The prediction model combinating with predicting variables for assessing acute anterior circulation ischemic stroke with endovascular treatment prognosis had some predictive value.