A Dynamic Nomogram to Identify Patients at High Risk of Poor Outcome in Stroke Patients with Chronic Kidney Disease

Abstract

Background and Purpose Predicting poor outcome for stroke patients with chronic kidney disease (CKD) in clinical practice is difficult. There are no tools available to use for predicting poor outcome in these patients. We aimed to construct and validate a dynamic nomogram to identify CKD–stroke patients at high risk of a 3-month poor outcome. Patients and Methods We used data for 502 CKD patients who had an acute ischemic stroke, from Nanjing First Hospital, between September 2014 and September 2020, to train the nomogram. An additional 108 patients enrolled from October 2020 to May 2021 were used for temporal external validation. The performance of the nomogram was evaluated by the area under the receiver operating characteristics curve (AUC) and a calibration plot. The clinical utility of the nomogram was measured by decision curve analysis (DCA) and the clinical impact curve (CIC). Results The median age of the cohort was 79 (70–84) years. Age, urea, premorbid modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS) on admission, hemiplegia, mechanical thrombectomy, early neurological deterioration, and respiratory infection were used as predictors of 3-month poor outcome to develop the nomogram. In the training set, the AUC of the dynamic nomogram was 0.873 and the calibration plot showed good predictive ability, and both DCA and CIC indicated the excellent clinical usefulness and applicability of the nomogram. In the external validation set, the AUC was 0.875 and the calibration plot also showed good agreement. Conclusion This is the first dynamic nomogram constructed for CKD–stroke patients to precisely and expediently identify patients with a high risk of 3-month poor outcome. The outstanding performance and great clinical predictive utility demonstrated the ability of the dynamic nomogram to help clinicians to deploy preventive interventions.

Chronic Kidney Disease Increases Mortality and Reduces the Chance of a Favorable Outcome in Stroke Patients Treated with Mechanical Thrombectomy—Single-Center Study

“…AF is a condition associated with CKD in stroke patients in most studies [ 14 , 17 , 18 , 22 , 27 , 28 , 29 , 30 , 47 , 50 , 51 ]. Patients with a concomitant AF and lower eGFR have an increased risk of stroke [ 52 , 53 ], as well as poorer outcomes, higher mortality and stroke recurrence [ 12 , 50 , 54 ] after a stroke treatment. Wang et al showed in their study that a reduced eGFR more than doubled the risk of death in patients with ischemic stroke and AF 3, 6 and 12 months after stroke (OR: 2.203; CI95%: 1.235–3.929 on the 12th month) [ 54 ].…”

“…In addition, the incidence of intracranial hemorrhage (ICH) significantly increases in CKD patients after a thrombolytic treatment, with the risk of symptomatic ICH being 1.4–1.6 times higher than in patients without CKD [ 9 , 10 ]. In one study, Wang et al proposed a dynamic nomogram as a prognostic tool for predicting adverse outcomes three months after stroke in patients with CKD, with an AUC (area under the curve) of 0.875 [ 12 ]. This nomogram, composed of eight independent factors, showed that mechanical thrombectomy (MT) reduced the likelihood of poor outcomes in this patient group (OR = 0.373, 95% CI: 0.145–0.964, p = 0.042).…”