A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China
Cerebral edema (CDE) is a common complication in patients with acute ischemic stroke (AIS) and can reduce the benefit of endovascular therapy (EVT). To determine whether certain risk factors are associated with a poor prognosis mediated by CDE after EVT. The 759 patients with anterior circulation st...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Aging Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnagi.2021.796434/full |
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| author | Zhi-Xin Huang Zhi-Xin Huang Zhi-Xin Huang Yong-Kun Li Yong-Kun Li Shi-Zhan Li Xian-Jun Huang Ying Chen Quan-Long Hong Qian-Kun Cai Yun-Fei Han |
| author_facet | Zhi-Xin Huang Zhi-Xin Huang Zhi-Xin Huang Yong-Kun Li Yong-Kun Li Shi-Zhan Li Xian-Jun Huang Ying Chen Quan-Long Hong Qian-Kun Cai Yun-Fei Han |
| author_sort | Zhi-Xin Huang |
| collection | DOAJ |
| description | Cerebral edema (CDE) is a common complication in patients with acute ischemic stroke (AIS) and can reduce the benefit of endovascular therapy (EVT). To determine whether certain risk factors are associated with a poor prognosis mediated by CDE after EVT. The 759 patients with anterior circulation stroke treated by EVT at three comprehensive stroke centers in China from January 2014 to October 2020 were analyzed. Patients underwent follow-up for 3 months after inclusion. The primary endpoint was a measure of a poor prognosis (modified Rankin Scale score ≥ 3) at 3 months assessed in all patients receiving EVT. Least absolute shrinkage and selection operator and multivariate logistic regression were used to select variables for the prognostic nomogram. Based on these variables, the nomogram was established and validated. In addition, structural equation modeling was used to explore the pathways linking CDE and a poor prognosis. Seven predictors were identified, namely, diabetes, age, baseline Alberta Stroke Program Early CT score, modified Thrombolysis in Cerebral Infarction score, early angiogenic CDE, National Institutes of Health Stroke Scale score, and collateral circulation. The nomogram consisting of these variables showed the best performance, with a large area under the curve in both the internal validation set (0.850; sensitivity, 0.737; specificity, 0.887) and external validation set (0.875; sensitivity, 0.752; specificity, 0.878). In addition, CDE (total path coefficient = 0.24, P < 0.001) served as a significant moderator. A nomogram for predicting a poor prognosis after EVT in AIS patients was established and validated with CDE as a moderator. |
| first_indexed | 2024-12-15T00:36:50Z |
| format | Article |
| id | doaj.art-3ded8b163f574c948c21463d7573e2d5 |
| institution | Directory Open Access Journal |
| issn | 1663-4365 |
| language | English |
| last_indexed | 2024-12-15T00:36:50Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Aging Neuroscience |
| spelling | doaj.art-3ded8b163f574c948c21463d7573e2d52022-12-21T22:41:47ZengFrontiers Media S.A.Frontiers in Aging Neuroscience1663-43652021-12-011310.3389/fnagi.2021.796434796434A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern ChinaZhi-Xin Huang0Zhi-Xin Huang1Zhi-Xin Huang2Yong-Kun Li3Yong-Kun Li4Shi-Zhan Li5Xian-Jun Huang6Ying Chen7Quan-Long Hong8Qian-Kun Cai9Yun-Fei Han10Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, ChinaDepartment of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaThe School of Medicine, Jinan University, Guangzhou, ChinaDepartment of Neurology, Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, ChinaDepartment of Neurology, The No. 1 People’s Hospital of Yulin, Yulin, ChinaDepartment of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaDepartment of Neurology, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, ChinaDepartment of Neurology, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China0Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China1Department of Neurology, Medical School of Nanjing University, Jinling Hospital, Nanjing, ChinaCerebral edema (CDE) is a common complication in patients with acute ischemic stroke (AIS) and can reduce the benefit of endovascular therapy (EVT). To determine whether certain risk factors are associated with a poor prognosis mediated by CDE after EVT. The 759 patients with anterior circulation stroke treated by EVT at three comprehensive stroke centers in China from January 2014 to October 2020 were analyzed. Patients underwent follow-up for 3 months after inclusion. The primary endpoint was a measure of a poor prognosis (modified Rankin Scale score ≥ 3) at 3 months assessed in all patients receiving EVT. Least absolute shrinkage and selection operator and multivariate logistic regression were used to select variables for the prognostic nomogram. Based on these variables, the nomogram was established and validated. In addition, structural equation modeling was used to explore the pathways linking CDE and a poor prognosis. Seven predictors were identified, namely, diabetes, age, baseline Alberta Stroke Program Early CT score, modified Thrombolysis in Cerebral Infarction score, early angiogenic CDE, National Institutes of Health Stroke Scale score, and collateral circulation. The nomogram consisting of these variables showed the best performance, with a large area under the curve in both the internal validation set (0.850; sensitivity, 0.737; specificity, 0.887) and external validation set (0.875; sensitivity, 0.752; specificity, 0.878). In addition, CDE (total path coefficient = 0.24, P < 0.001) served as a significant moderator. A nomogram for predicting a poor prognosis after EVT in AIS patients was established and validated with CDE as a moderator.https://www.frontiersin.org/articles/10.3389/fnagi.2021.796434/fullischemic strokeendovascular therapyprognosisnomogramrisk factor |
| spellingShingle | Zhi-Xin Huang Zhi-Xin Huang Zhi-Xin Huang Yong-Kun Li Yong-Kun Li Shi-Zhan Li Xian-Jun Huang Ying Chen Quan-Long Hong Qian-Kun Cai Yun-Fei Han A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China Frontiers in Aging Neuroscience ischemic stroke endovascular therapy prognosis nomogram risk factor |
| title | A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China |
| title_full | A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China |
| title_fullStr | A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China |
| title_full_unstemmed | A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China |
| title_short | A Dynamic Nomogram for 3-Month Prognosis for Acute Ischemic Stroke Patients After Endovascular Therapy: A Pooled Analysis in Southern China |
| title_sort | dynamic nomogram for 3 month prognosis for acute ischemic stroke patients after endovascular therapy a pooled analysis in southern china |
| topic | ischemic stroke endovascular therapy prognosis nomogram risk factor |
| url | https://www.frontiersin.org/articles/10.3389/fnagi.2021.796434/full |
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