External Validation of START nomogram to predict 3-Month unfavorable outcome in Chinese acute stroke patients
External Validation of START nomogram to predict 3-Month unfavorable outcome in Chinese acute stroke patients
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START 列线图预测中国急性卒中患者 3 个月不良结果的外部验证
DOI：
10.1016/j.jstrokecerebrovasdis.2019.02.032
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发表时间：
2019
影响因子：
2.5
通讯作者：
Zou JianJun
中科院分区：
文献类型：
--
作者：
Song BaiLi;Chen XiangLiang;Tang Dan;Ibrahim Mako;Liu YuKai;Nyame Linda;Jiang Teng;Wang Wei;Li Xiang;Sun Chao;Zhao Zheng;Yang Jie;Zhou JunShan;Zou JianJun
近年来，NIHSS卒中评分、年龄、卒中前MRS评分、发病至治疗时间(Start Normap)预测了缺血性卒中患者静脉溶栓后3个月的功能结果。然而，这一模型还没有得到外部的验证。方法数据来源于南京市第一医院卒中中心(中国)。缺乏必要的数据来计算诺模图并错过3个月修正排名量表得分的患者被排除在外。3个月时改良Rankin评分超过2分被评估为不良结果。我们使用受试者操作特征曲线下面积(AUC-ROC)来量化预后价值。校正通过校正曲线图和Hosmer-Lemesshow(HL)拟合优度测试进行评估。结果最终队列包括306名合格患者。对于3个月的不良结果，开始图的AUC-ROC为.766(95%CI：.7013-.8304，P<；.0001)，表明开始图具有良好的区分度。在外部验证样本中具有良好的校正能力(HL拟合度检验P= .1261)。结论起始诺模图具有良好的预测性能，是预测急性卒中后不良预后的可靠、简便的临床工具。
BackgroundRecently, the NIHSS STroke Scale score, Age, pre-stroke mRS score, onset-to-treatment Time (START nomogram) predicts 3-month functional outcome after intravenous thrombolysis in ischemic stroke patients. However, this model has not yet been an external validation. We aim to validate the performance of START nomogram.MethodsData were derived from the stroke center of the Nanjing First Hospital (China). Patients who lacked the necessary data to calculate the nomogram and missed 3-month modified Ranking scale scores were excluded. Modified Rankin Scale score more than 2 at 3-month was assessed as an unfavorable outcome. We used areas under the receiver operator characteristic curves (AUC-ROC) to quantify the prognostic value. Calibration was assessed by calibration plots and Hosmer-Lemeshow (HL) goodness of fit test.ResultThe final cohort included 306 eligible patients. For 3-month unfavorable outcome, the AUC-ROC of the START nomogram was .766 (95%CI: .7013-.8304,P< .0001), suggesting good discrimination in the START nomogram. It also showed good calibration (HL goodness of fit testP= .1261) in the external validation sample.ConclusionThe START nomogram with good predictive performance is a reliable and simple clinical instrument to predict unfavorable outcome after acute stroke.