对柏林中风后死亡率风险预测模型的外部验证
Lukas Reitzle1,2, Jessica L Rohmann2,3, Tobias Kurth3
1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany reitzlel@rki.de.
BMJ open
|June 6, 2025
概括
两种中风死亡率预测模型在德国柏林表现良好. 虽然对于大多数患者来说都是准确的,但这两种模型都低估了高风险个体的风险,强调了需要仔细解释的需要.
科学领域:
- 神经学 神经学
- 流行病学 流行病学
- 生物统计学 生物统计学
背景情况:
- 对中风后死亡率预测模型的外部验证对于评估它们在现实世界中的适用性至关重要.
- 现有的模型往往在不同的地理环境中缺乏验证,这限制了它们的通用性.
研究的目的:
- 评估德国队列中两种已建立的中风后死亡率预测模型的性能.
- 评估这些模型的校准和歧视,以预测30天和住院死亡率.
主要方法:
- 利用了来自柏林-S特定的急性治疗缺血性或出血性中风与长期随访 (B-SPATIAL) 注册表的数据.
- 验证的布雷等人. 这是30天和史密斯等人. 医院的医院死亡率预测模型使用校准和歧视指标.
- 包括被诊断患有缺血性中风,出血性中风或短暂缺血性发作的成年患者.
主要成果:
- 布雷和其他人. 该模型 (n=7879) 的c-统计值为0.865,观察到的死亡率为9.7%,预测30天死亡率为8.6%.
- 史密斯和其他人. 福尔摩斯的模型 (n=1931) 实现了0.891的c统计值,观察到的死亡率为5.4%,预测的住院死亡率为4.8%.
- 两种模型都表明,高风险患者群体的死亡风险被低估了.
结论:
- 评估的模型表现出良好的区分和可接受的校准低至中等风险中风患者在柏林.
- 这些发现表明,例行收集的数据可以支持有效的中风后死亡率预测,尽管高风险分层需要进一步细化.
- 外部验证对于确保预测模型在临床实践中的可靠应用至关重要.
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