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Development and Validation of a Nomogram for Predicting Lacunar Infarction in Patients with Hypertension
Jun Lu1, Huiqing Pan1, Jingjing Xing1
1Emergency Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China.
Insights
This study developed a nomogram to predict lacunar infarction in hypertensive patients. The tool identified age, diabetes, atrial fibrillation, hypertension duration, and LDL as key risk factors, aiding early risk assessment.
Area of Science:
- Neurology
- Cardiology
- Medical Informatics
Background:
- Hypertensive patients have a significant risk of lacunar infarction.
- Early identification of lacunar infarction risk is crucial for this population.
Purpose of the Study:
- To develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients.
- To provide a visualized tool for clinicians to assess patient risk.
Main Methods:
- Retrospective analysis of 314 hypertensive patients' clinical data.
- Development of a nomogram using LASSO and logistic regression to identify independent risk factors.
- Validation of the nomogram's discrimination, calibration, and clinical utility using ROC, calibration curves, and DCA.
Main Results:
- The nomogram identified age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein as independent predictors.
- The nomogram demonstrated strong discrimination (AUC 0.847 in training, 0.907 in validation sets) and good calibration.
- Decision curve analysis confirmed the nomogram's clinical usefulness across a range of threshold probabilities.
Conclusions:
- Age, diabetes, atrial fibrillation, hypertension duration, and LDL are significant predictors of lacunar infarction in hypertensive individuals.
- The developed nomogram is a valuable clinical tool for assessing lacunar infarction risk in hypertensive patients.
Background:
A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients.
Methods:
Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram's discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively.
Results:
The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089-1.198, P<0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396-6.697, P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328-7.250, P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045-1.222, P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250-3.688, P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789-0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838-0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets.
Conclusion:
Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.
