Nomogram to predict 3-month unfavorable outcome after thrombectomy for stroke

Abstract

Background Mechanical thrombectomy (MT) is an effective treatment for large-vessel occlusion in acute ischemic stroke, however, only some revascularized patients have a good prognosis. For stroke patients undergoing MT, predicting the risk of unfavorable outcomes and adjusting the treatment strategies accordingly can greatly improve prognosis. Therefore, we aimed to develop and validate a nomogram that can predict 3-month unfavorable outcomes for individual stroke patient treated with MT. Methods We analyzed 258 patients with acute ischemic stroke who underwent MT from January 2018 to February 2021. The primary outcome was a 3-month unfavorable outcome, assessed using the modified Rankin Scale (mRS), 3–6. A nomogram was generated based on a multivariable logistic model. We used the area under the receiver-operating characteristic curve to evaluate the discriminative performance and used the calibration curve and Spiegelhalter’s Z-test to assess the calibration performance of the risk prediction model. Results In our visual nomogram, gender (odds ratio [OR], 3.40; 95%CI, 1.54–7.54), collateral circulation (OR, 0.46; 95%CI, 0.28–0.76), postoperative mTICI (OR, 0.06; 95%CI, 0.01–0.50), stroke-associated pneumonia (OR, 5.76; 95%CI, 2.79–11.87), preoperative Na (OR, 0.82; 95%CI, 0.72–0.92) and creatinine (OR, 1.02; 95%CI, 1.01–1.03) remained independent predictors of 3-month unfavorable outcomes in stroke patients treated with MT. The area under the nomogram curve was 0.8791 with good calibration performance (P = 0.873 for the Spiegelhalter’s Z-test). Conclusions A novel nomogram consisting of gender, collateral circulation, postoperative mTICI, stroke-associated pneumonia, preoperative Na and creatinine can predict the 3-month unfavorable outcomes in stroke patients treated with MT.

A Glycemia-Based Nomogram for Predicting Outcome in Stroke Patients after Endovascular Treatment

“…Nomogram is a simple and intuitive tool for forecasting prognosis and assessing risk which could guide clinical treatment decisions. Several studies have proposed nomograms to predict outcome after thrombectomy [ 17 , 18 , 19 , 20 ]. Age, gender, pre-stroke mRS score, NIHSS score, collateral circulation, postoperative TICI score, and several other factors could be used to build a nomogram for predicting the possibility of poor outcome in patients receiving EVT [ 17 , 18 , 19 , 20 ].…”

“…Several studies have proposed nomograms to predict outcome after thrombectomy [ 17 , 18 , 19 , 20 ]. Age, gender, pre-stroke mRS score, NIHSS score, collateral circulation, postoperative TICI score, and several other factors could be used to build a nomogram for predicting the possibility of poor outcome in patients receiving EVT [ 17 , 18 , 19 , 20 ]. However, none of these studies explored the establishment of a prognostic model based on blood glucose.…”

“…Nomograms can generate a possibility of a clinical event individually through gathering personal biological and clinical variables and are extensively used in clinical practice [ 16 ]. Several nomograms were proposed to estimate the risk of unfavorable outcome at three months in stroke patients who received EVT recently [ 17 , 18 , 19 , 20 ]. Age, admission, the National Institute of Health Stroke Scale (NIHSS) score, collateral circulation, and the postoperative Modified Thrombolysis in Cerebral Infarction (mTICI) scale were commonly considered as independent predictors [ 17 , 18 , 19 , 20 ].…”

“…Several nomograms were proposed to estimate the risk of unfavorable outcome at three months in stroke patients who received EVT recently [ 17 , 18 , 19 , 20 ]. Age, admission, the National Institute of Health Stroke Scale (NIHSS) score, collateral circulation, and the postoperative Modified Thrombolysis in Cerebral Infarction (mTICI) scale were commonly considered as independent predictors [ 17 , 18 , 19 , 20 ]. However, the forecast performance of these models was discrepant, and few studies investigated the effect of glycemia on functional outcome after EVT.…”

Development and Validation of a Nomogram to Predict Hemiplegic Shoulder Pain in Patients With Stroke: A Retrospective Cohort Study

“…Wang et al 14 developed a nomogram for predicting dysphagia recovery in patients with stroke used to assist the decision making of enteral nutrition to achieve individualized swallowing rehabilitation. Zhang et al 15 also created a nomogram for the quantification of risks of unfavorable outcomes in patients with stroke undergoing mechanical thrombectomies, allowing clinicians to accurately assess the unfavorable outcome risks using easily accessible clinical parameters. Therefore, this study aimed to develop and internally validate a nomogram for the prediction of HSP in patients with stroke during inpatient rehabilitation.…”