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
ARTICLE HIGHLIGHTS
Research background

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

Research motivation

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

Research objectives

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

Research methods

The predictive accuracy of a nomogram model to predict the probability of unfavorable outcome was assessed by calculation of the area under the receiver operating characteristic curve (AUC-ROC). Calibration of the risk prediction model was assessed by a plot comparing the observed probability of unfavorable outcome against the predicted, and by using the Hosmer–Lemeshow test.

Research 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 (NIHSS) score, 424 for intracranial hemorrhage, and 247 for progressive stroke. Finally, 1244 patients were subjected for 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 serum total bilirubin (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).

Research conclusions

This study has developed and verified that the nomogram can provide individualized, intuitive, and accurate prediction for the recurrence of mild ischemic stroke inpatients in China.

Research perspectives

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