Construction and evaluation of a short-term prognostic model for acute ischemic stroke in emergency settings

Article ID: 4575

Keywords: acute ischemic stroke; prediction model; frailty screening questionnaire

Abstract

Objective: To develop a prediction model for 14-day poor prognosis in acute ischemic stroke (AIS) patients in emergency settings and evaluate its predictive accuracy. Methods: We conducted a prospective cohort study, enrolling AIS patients admitted to our hospital between October 2018 and December 2020, within 72 h of symptom onset. Univariate and multivariate logistic regression analyses were performed to identify factors associated with poor prognosis. Receiver operating characteristic (ROC) curves were used to determine cutoff values for continuous variables, which were subsequently discretized based on clinical relevance. A clinical scoring model for short-term prognosis was constructed using the β coefficients of selected variables. AIS patients admitted between January and December 2021 served as the internal validation cohort to assess the model’s performance. Results: A total of 321 patients were included, with 223 in the training cohort and 98 in the validation cohort. Multivariate logistic regression identified age, high-sensitivity C-reactive protein(hs-CRP), prealbumin (PA), infarct volume, Frailty Screening Questionnaire (FSQ), and National Institutes of Health Stroke Scale (NIHSS) scores as independent predictors of poor short-term prognosis. The prognostic scoring system, with a total score of 15, included the following components: age ≥ 74 years (1 point), PA ≤ 373 mg/L (2 points), large-artery atherosclerosis (1 point), cardioembolic stroke (2 points), infarct volume ≥ 2.18 cm³ (2 points), FSQ score ≥ 3 (1 point), and NIHSS score ≥ 4 (6 points). The area under the ROC curve (AUC) for predicting poor prognosis was 0.927 (95%CI: 0.894~0.960), with an optimal cutoff score of ≥5 points, yielding a sensitivity of 0.770 and specificity of 0.976. The model’s performance in the validation cohort was consistent, with an AUC of 0.892 (95%CI: 0.827~0.957). Conclusion: The short-term prognostic scoring system for AIS demonstrated strong diagnostic accuracy and offers valuable guidance for clinicians in early prognosis assessment in emergency settings.