Association of Silent Cerebrovascular Disease Identified Using Natural Language Processing and Future Ischemic Stroke
Association of Silent Cerebrovascular Disease Identified Using Natural Language Processing and Future Ischemic Stroke
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DOI：
10.1212/wnl.0000000000012602
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发表时间：
2021-09-28
期刊：
影响因子：
9.9
通讯作者：
Chen, Wansu
中科院分区：
文献类型：
--
作者：
Kent, David M.;Leung, Lester Y.;Chen, Wansu
背景与目的无症状性脑血管病(SCD)包括无症状性脑梗塞(SBI)和脑白质病(WMD)，常见于临床常规的神经影像检查。它们的预后意义尚不清楚。我们的目标是评估偶然发现的SCD患者未来卒中的发生率和风险增加。方法纳入2009年至2019年间在南加州凯撒永久医疗系统(KPSC)接受头颅CT或MRI检查的患者，年龄<50岁，既往无缺血性中风、短暂性脑缺血发作(TIA)或痴呆/阿尔茨海默病。通过神经影像报告中的自然语言处理(NLP)识别SBI和WMD。结果在262,875名接受神经影像检查的受试者中，NLP发现13,154名(5.0%)患有SBI，78,330名(29.8%)患有WMD。未来卒中发生率为32.5(95%可信区间[CI]31.1，33.9)/1000患者年：有WMD患者19.3(95%可信区间18.9，19.8)，无SCD患者6.8(95%CI 6.7，7.0)。与SBI相关的粗危比(HR)为3.40(95%CI为3.25~3.56)，与WMD相关的粗危比为2.63(95%CI为2.54~2.71)。对于MRI发现的SBI，对于65岁的患者，调整后的HR为2.95(95%CI为2.53至3.44)。CT扫描调整后的心率为2.48(95%可信区间为2.19~2.81)。与发现WMD相关的调整后的HR为1.76(95%可信区间为1.69至1.82)，且不受年龄或成像方式的影响。讨论顺便发现，SBI和WMD是常见的，并与随后的症状性中风的风险增加相关，这是预防中风的重要机会。
Background and Objectives Silent cerebrovascular disease (SCD), comprising silent brain infarction (SBI) and white matter disease (WMD), is commonly found incidentally on neuroimaging scans obtained in routine clinical care. Their prognostic significance is not known. We aimed to estimate the incidence of and risk increase in future stroke in patients with incidentally discovered SCD. Methods Patients in the Kaiser Permanente Southern California (KPSC) health system aged >= 50 years, without prior ischemic stroke, transient ischemic attack (TIA), or dementia/Alzheimer disease receiving a head CT or MRI between 2009 and 2019 were included. SBI and WMD were identified by natural language processing (NLP) from the neuroimage report. Results Among 262,875 individuals receiving neuroimaging, NLP identified 13,154 (5.0%) with SBI and 78,330 (29.8%) with WMD. The incidence of future stroke was 32.5 (95% confidence interval [CI] 31.1, 33.9) per 1,000 patient-years for patients with SBI: 19.3 (95% CI 18.9, 19.8) for patients with WMD and 6.8 (95% CI 6.7, 7.0) for patients without SCD. The crude hazard ratio (HR) associated with SBI was 3.40 (95% CI 3.25 to 3.56) and for WMD 2.63 (95% CI 2.54 to 2.71). With MRI-discovered SBI, the adjusted HR was 2.95 (95% CI 2.53 to 3.44) for those = 65. With CT scan, the adjusted HR was 2.48 (95% CI 2.19 to 2.81) for those = 65. The adjusted HR associated with a finding of WMD was 1.76 (95% CI 1.69 to 1.82) and was not modified by age or imaging modality. Discussion Incidentally discovered SBI and WMD are common and associated with increased risk of subsequent symptomatic stroke, representing an important opportunity for stroke prevention.