Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9440-9451
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9440
Risk factors for relapse and nomogram for relapse probability prediction in patients with minor ischemic stroke
Xian-Feng Yu, Wen-Wen Yin, Chao-Juan Huang, Xin Yuan, Yu Xia, Wei Zhang, Xia Zhou, Zhong-Wu Sun
Xian-Feng Yu, Wen-Wen Yin, Chao-Juan Huang, Xin Yuan, Yu Xia, Wei Zhang, Xia Zhou, Zhong-Wu Sun, Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Yu XF designed and performed the research and wrote the paper; Sun ZW designed the research and supervised the report; Yin WW designed the research and contributed to the analysis; Huang CJ, Yuan X, Xia Y, Zhang W, and Zhou X provided clinical advice; Sun ZW supervised the report.
Supported by the National Natural Science Foundation of China (No. 81771154); and the Natural Science Foundation of Anhui Province (No. 1908085QH322).
Institutional review board statement: The study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University.
Informed consent statement: As this is a retrospective study, written informed consent was waived.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong-Wu Sun, MD, Department of Neurology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui Province, China. sunzhwu@126.com
Received: March 15, 2021
Peer-review started: March 15, 2021
First decision: April 4, 2021
Revised: April 15, 2021
Accepted: September 29, 2021
Article in press: September 29, 2021
Published online: November 6, 2021
Processing time: 228 Days and 8.7 Hours
Abstract
BACKGROUND

The identification of risk factors for recurrence in patients with minor ischemic stroke (MIS) is a critical medical need.

AIM

To develop a nomogram for individualized prediction of in-hospital recurrence in MIS patients.

METHODS

Based on retrospective collection, a single-center study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2019. Univariate and multivariate logistic regression analyses were used to determine the risk factors associated with MIS recurrence. The least absolute shrinkage and selection operator regression was performed for preliminary identification of potential risk factors. Uric acid, systolic blood pressure, serum total bilirubin (STBL), and ferritin were integrated for nomogram construction. The predictive accuracy and calibration of the nomogram model were assessed by the area under the receiver operating characteristic curve (AUC-ROC) and Hosmer-Lemeshow test, respectively.

RESULTS

A total of 2216 MIS patients were screened. Among them, 155 were excluded for intravascular therapy, 146 for unknown National Institutes of Health Stroke Scale score, 195 for intracranial hemorrhage, and 247 for progressive stroke. Finally, 1244 patients were subjected to further analysis and divided into a training set (n = 796) and a validation set (n = 448). Multivariate logistic regression analysis revealed that uric acid [odds ratio (OR): 0.997, 95% confidence interval (CI): 0.993-0.999], ferritin (OR: 1.004, 95%CI: 1.002-1.006), and STBL (OR: 0.973, 95%CI: 0.956-0.990) were independently associated with in-hospital recurrence in MIS patients. Our model showed good discrimination; the AUC-ROC value was 0.725 (95%CI: 0.646-0.804) in the training set and 0.717 (95%CI: 0.580-0.785) in the validation set. Moreover, the calibration between nomogram prediction and the actual observation showed good consistency. Hosmer-Lemeshow test results confirmed that the nomogram was well-calibrated (P = 0.850).

CONCLUSION

Our present findings suggest that the nomogram may provide individualized prediction of recurrence in MIS patients.

Keywords: Minor ischemic stroke; Recurrence; Risk factor; Nomogram; Prediction; Chinese ethnic

Core tip: The identification of risk factors for recurrence in patients with minor ischemic stroke (MIS) is a critical medical need. Based on retrospective collection, a single-center study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2019. Univariate and multivariate logistic regression analyses were used to determine the risk factors associated with MIS recurrence. The developed nomogram may provide individualized prediction of recurrence of MIS inpatients.