Developing a nomogram model for 3-month prognosis in patients who had an acute ischaemic stroke after intravenous thrombolysis: a multifactor logistic regression model approach.

ABSTRACT

OBJECTIVES: This study is to establish a nomination graph model for individualised early prediction of the 3-month prognosis of patients who had an acute ischaemic stroke (AIS) receiving intravenous thrombolysis with recombinant tissue plasminogen activator. DESIGN: For the period from January 2016 through August 2022, 991 patients who had an acute stroke eligible for intravenous thrombolysis were included in the retrospective analysis study. The study was based on multifactor logistic regression. PARTICIPANTS: Patients who received treatment from January 2016 to February 2021 were included in the training cohort, and those who received treatment from March 2021 to August 2022 were included in the testing cohort. INTERVENTIONS: Each patient received intravenous thrombolysis within 4.5 hours of onset, with treatment doses divided into standard doses (0.9 mg/kg). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was a 3-month adverse outcome (modified Rankin Scale 3-6). RESULTS: The National Institutes of Health Stroke Scale Score after thrombolysis (OR=1.18; 95% CI 1.04 to 1.36; p = 0.015), door-to-needle time (OR=1.01; 95% CI 1.00 to 1.02; p = 0.003), baseline blood glucose (OR=1.08; 95% CI 1.00 to 1.16; p=0.042), blood homocysteine (OR=7.14; 95% CI 4.12 to 12.71; p<0.001), monocytes (OR=0.05; 95% CI 0.01 to 0.043; p=0.005) and monocytes/high-density lipoprotein (OR=62.93; 95% CI 16.51 to 283.08; p<0.001) were independent predictors of adverse outcomes 3 months after intravenous thrombolysis, and the above six factors were included in the nominated DGHM2N nomogram. The area under the receiver operating characteristic curve value of the training cohort was 0.870 (95% CI 0.841 to 0.899) and in the testing cohort was 0.822 (95% CI 0.769 to 0.875). CONCLUSIONS: A reliable nomogram model (DGHM2N model) was developed and validated in this study. This nomogram could individually predict the adverse outcome of patients who had an AIS receiving intravenous thrombolysis with alteplase for 3 months.