Title:Nomogram to Predict 90-Day All-Cause Mortality in Acute Ischemic Stroke Patients after Endovascular Thrombectomy
Volume: 21
Issue: 3
Author(s): Shiya Zhang, Shuai Yu, Xiaocui Wang, Zhiliang Guo, Jie Hou, Huaishun Wang, Zhichao Huang, Guodong Xiao*Shoujiang You*
Affiliation:
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital
of Soochow University, Suzhou, 215004, China
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital
of Soochow University, Suzhou, 215004, China
Keywords:
Ischemic stroke, large vessel occlusion, endovascular thrombectomy, nomogram, risk prediction model, 90-day allcause mortality.
Abstract:
Objective: Although Endovascular Thrombectomy (EVT) significantly improves the
prognosis of Acute Ischemic Stroke (AIS) patients with large vessel occlusion, the mortality rate
remains higher. This study aimed to construct and validate a nomogram for predicting 90-day
all-cause mortality in AIS patients with large vessel occlusion and who have undergone EVT.
Methods: AIS patients with large vessel occlusion in the anterior circulation who underwent
EVT from May 2017 to December 2022 were included. 430 patients were randomly split into a
training group (N=302) and a test group (N=128) for the construction and validation of our
nomogram. In the training group, multivariate logistic regression analysis was performed to determine
the predictors of 90-day all-cause mortality. The C-index, calibration plots, and decision
curve analysis were applied to evaluate the nomogram performance.
Results: Multivariate logistic regression analysis revealed neurological deterioration during hospitalization,
age, baseline National Institutes of Health Stroke Scale (NIHSS) score, occlusive
vessel location, malignant brain edema, and Neutrophil-to-lymphocyte Ratio (NLR) as the independent
predictors of 90-day all-cause mortality (all p ≤ 0.039). The C-index of the training and
test groups was 0.891 (95%CI 0.848-0.934) and 0.916 (95% CI: 0.865-0.937), respectively,
showing the nomogram to be well distinguished. The Hosmer-Lemeshow goodness-of-fit test
revealed the p-values for both the internal and external verification datasets to be greater than
0.5.
Conclusion: Our nomogram has incorporated relevant clinical and imaging features, including
neurological deterioration, age, baseline NIHSS score, occlusive vessel location, malignant brain
edema, and NLR ratio, to provide an accurate and reliable prediction of 90-day all-cause mortality
in AIS patients undergoing EVT.
