PDF(Pubmed)
Abstract：
UNASSIGNED: There is no established prognostic scoring system developed for patients with large hemispheric infarction (LHI) following decompressive craniectomy (DC) based on imaging characteristics. The present study aimed to develop and validate a new computed tomography scoring model to assess the 6-month risk of poor functional outcomes (modified-Rankin scale [mRS] score of 4-6) in patients with LHI receiving DC.
UNASSIGNED: This retrospective cohort study included patients at two tertiary stroke centers. A prediction model was developed based on a multivariable logistic regression. The final risk factors included the ASPECTS (Alberta Stroke Program Early Computed Tomography Score), longitudinal fissure cistern, Sylvian fissure cistern, and additional vascular territory involvement. 1,000 bootstrap resamples and temporal validation were implemented as validations for the scoring system.
UNASSIGNED: Of the 100 individuals included in the development cohort, 71 had poor functional outcomes. The scoring model presented excellent discrimination and calibration with C-index = 0.87 for the development cohort, and C-index = 0.83 for the temporal validation cohort with non-significant Hosmer-Lemeshow goodness-of-fit test. The scoring model also showed an improved AUC compared to the ASPECTS. For each point in the score model, the adjusted risk of poor functional outcomes increase by 47.8% (OR = 1.48, p < 0.001). The scores were inversely correlated with MAP (mean arterial pressure, paired t-test, p = 0.0015) and CPP (cerebral perfusion pressure, rho = -0.17, p = 0.04).
UNASSIGNED: In patients with LHI following DC, the score system is an excellent predictor of poor functional outcomes and is associated with CPP and MAP, which might be worth considering in clinical settings after further external validation.
UNASSIGNED: This retrospective cohort study included patients at two tertiary stroke centers. A prediction model was developed based on a multivariable logistic regression. The final risk factors included the ASPECTS (Alberta Stroke Program Early Computed Tomography Score), longitudinal fissure cistern, Sylvian fissure cistern, and additional vascular territory involvement. 1,000 bootstrap resamples and temporal validation were implemented as validations for the scoring system.
UNASSIGNED: Of the 100 individuals included in the development cohort, 71 had poor functional outcomes. The scoring model presented excellent discrimination and calibration with C-index = 0.87 for the development cohort, and C-index = 0.83 for the temporal validation cohort with non-significant Hosmer-Lemeshow goodness-of-fit test. The scoring model also showed an improved AUC compared to the ASPECTS. For each point in the score model, the adjusted risk of poor functional outcomes increase by 47.8% (OR = 1.48, p < 0.001). The scores were inversely correlated with MAP (mean arterial pressure, paired t-test, p = 0.0015) and CPP (cerebral perfusion pressure, rho = -0.17, p = 0.04).
UNASSIGNED: In patients with LHI following DC, the score system is an excellent predictor of poor functional outcomes and is associated with CPP and MAP, which might be worth considering in clinical settings after further external validation.
摘要：
■没有针对大骨瓣减压术（DC）后的半球性梗死（LHI）患者建立的基于影像学特征的预后评分系统。本研究旨在开发和验证一种新的计算机断层扫描评分模型，以评估接受DC的LHI患者的6个月不良功能结局（改良Rankin量表[mRS]评分为4-6）的风险。
■这项回顾性队列研究纳入了两个三级卒中中心的患者。建立了基于多变量逻辑回归的预测模型。最终的危险因素包括ASPECTS（艾伯塔省卒中计划早期计算机断层扫描评分），纵裂池,西尔维安裂隙池,和额外的血管区域参与。1,000个引导重新采样和时间验证被实施为评分系统的验证。
■在发展队列中的100个人中，71具有较差的功能结果。评分模型对发展队列的C指数=0.87具有出色的辨别和校准，对于具有非显著Hosmer-Lemeshow拟合优度检验的时间验证队列，C指数=0.83。评分模型还显示与ASPECTS相比改善的AUC。对于分数模型中的每个点，校正后不良功能结局风险增加47.8%(OR=1.48,p<0.001).评分与MAP(平均动脉压，配对t检验，p=0.0015)和CPP(脑灌注压，rho=-0.17，p=0.04)。
■在DC后出现LHI的患者中，评分系统是不良功能结局的一个很好的预测指标，并且与CPP和MAP相关，在进一步的外部验证后，这可能值得在临床环境中考虑。
■这项回顾性队列研究纳入了两个三级卒中中心的患者。建立了基于多变量逻辑回归的预测模型。最终的危险因素包括ASPECTS（艾伯塔省卒中计划早期计算机断层扫描评分），纵裂池,西尔维安裂隙池,和额外的血管区域参与。1,000个引导重新采样和时间验证被实施为评分系统的验证。
■在发展队列中的100个人中，71具有较差的功能结果。评分模型对发展队列的C指数=0.87具有出色的辨别和校准，对于具有非显著Hosmer-Lemeshow拟合优度检验的时间验证队列，C指数=0.83。评分模型还显示与ASPECTS相比改善的AUC。对于分数模型中的每个点，校正后不良功能结局风险增加47.8%(OR=1.48,p<0.001).评分与MAP(平均动脉压，配对t检验，p=0.0015)和CPP(脑灌注压，rho=-0.17，p=0.04)。
■在DC后出现LHI的患者中，评分系统是不良功能结局的一个很好的预测指标，并且与CPP和MAP相关，在进一步的外部验证后，这可能值得在临床环境中考虑。
