在缺血性中风和过渡性缺血性发作后,在稳定的门诊患者中预测1年的中风复发和死亡率
Alisia Southwell1, Anne Marie Liddy2, Anna Chu3
1Evaluative Clinical Sciences Platform, https://ror.org/03dbr7087Sunnybrook Research Institute, Toronto, ON, Canada.
概括
在门诊环境中预测中风复发和死亡率是具有挑战性的. 人口统计和病史数据显示预测准确度低,突显了对二次中风预防的新方法的需求.
科学领域:
- 神经学 神经学
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 在中风或过渡性缺血性攻击 (TIA) 中幸存下来的患者面临着显著的早期死亡和发病风险.
- 现有的风险预测工具主要是为医院出院后设计的,而不是为参加门诊随访的患者设计的.
- 这项研究调查了在门诊环境中使用人口统计和病史数据预测1年中风复发和死亡率的可预测性.
研究的目的:
- 评估人口统计和病史数据在预测1年中风复发和全因死亡率方面的有效性.
- 评估模型的预测准确性,用于那些在中风或TIA中幸存下来并正在门诊随访的患者.
- 识别二次中风预防当前风险预测中的潜在差距.
主要方法:
- 利用了来自安大略省中风登记处的数据,包括13,848名中风和13,059名TIA患者,与行政数据库链接.
- 采用多变量回归模型,每个队列的三分之二用于模型导出,三分之一用于验证.
- 分析了人口因素,病史和临床结果,包括中风复发率和死亡率.
主要成果:
- 在缺血性中风队列中报告了2.71%的复发性中风,在一年后的TIA队列中报告了3.44%.
- 确定年龄的增长和先前的中风/TIA作为两组人群中复发的风险因素.
- 在验证队列中发现了中风复发的适度预测准确性 (AUC0.59) 和死亡率的中等准确性 (C-统计数据0.74-0.78).
结论:
- 开发的中风复发模型的预测准确性很低,即使考虑到多种风险因素.
- 需要确定特定于门诊中风诊所患者群体的额外风险因素.
- 针对个性化二次中风预防的创新策略对于改善患者的治疗结果至关重要.
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