Risk Factors And Predictive Scoring System For Progressive Ischemic Stroke

Objectives Screen the risk factors of progressive ischemic stroke(PIS),and construct a predictive scoring system for PIS based on these risk factors,which is convenient for clinical application and can provide the basis for its prevention and treatment.Methods Collected 186 patients with acute cerebral infarction who were hospitalized from Tangshan Workers' Hospital from December 2015 to December 2016.All the patients were scored by NIHSS Score when they admited to hospital and when their condition changed.According to the NIHSS Score,if the score increased 2 points or more from 6 hours to 7days of oneset,patients were divided into PIS group.And others were divided into NPIS group.PIS group includes 86 cases and NPIS group includes 100 cases.Collect related indicators which may affect the aggravation of disease,including gender,age,past medical history,smoking and drinking history,fever,infection,obesity,BMI,white blood cell count,fasting blood glucose,fibrinogen,blood lipid,homocysteine,CRP,uric acid,blood pressure on admission and changes of blood pressure,anemia,carotid plaque,stenosis degree of responsible vascular,infarction sites,admission NIHSS score and the condition changes of NIHSS scores.The univariate analysis and multivariate Logistic regression analysis were used to select risk factors,and established the Logistic regression equation.Based on b coefficient of each factor,the predictive scoreing system of PIS were constructed by “scoring method”.The predictive scoring system for PIS was evaluated by ROC curve,paired chi-square test and consistency test.Results 1 Univariate analysis: drinking history,fever,infection,triglyceride,CRP,uric acid,infection,excessive drinking,white blood cell count,CRP,uric acid,admission systolic blood pressure,decreased blood pressure after infarction,moderate to severe stenosis of responsible vascular,posterior limb of internal capsule infarction,watershed infarction were significantly different between PIS group and NPIS group(P<0.05).Gender,age,history of hypertension,coronary heart disease,diabetes,atrial fibrillation,cerebral stroke/TIA,smoking history,obesity,fasting blood glucose,fibrinogen,total cholesterol,low density lipoprotein cholesterol,homocysteine,admission diastolic blood pressure,anemia,carotid artery plaque,unstable carotid plaque,OCSP,pontine infarction and admission NIHSS score were not significant between the two groups(P>0.05).2Multivariate logistic regression analysis: 7 factors eventually entered into the logistic regression model including BMI,drinking history,decreased blood pressure after infarction,moderate to severe stenosis of responsible vascular,posterior limb of internal capsule infarction,watershed infarction and fever.And they are independent risk factors for PIS.The odds ratio(OR)of each factor respectively is 1.300,4.027,15.852,4.702,4.322,4.185,11.999.3 The prective logistic regression model of PIS was constructed:Logit P=10.035+0.262X1+1.393X2+2.763X3+1.548X4+1.464X5+1.432X6+2.458X7(Note: X1: BMI,X2: excessive drinking,X3: decreased blood pressure after infarction,X4: moderate to severe stenosis of responsible vascular,X5: posterior limb of internal capsule infarction,X6: watershed infarction,X7: fever).4 The predictive scoring system for PIS is 10 points and the prediction value is 4 points.ROC curve area is 0.911,and the evaluation results are as follows: sensitivity(0.860),specificity of(0.920),the total coincidence rate(0.892),the positive likelihood ratio(10.750),negative likelihood ratio(0.152),Kappa value(0.783).Conclusions 1 BMI,drinking history,decreased blood pressure after infarction,moderate to severe stenosis of responsible vascular,posterior limb of internal capsule infarction,watershed infarction and fever are the important risk factors of PIS.2 The predictive scoring system for PIS,which has good evaluation effect and clinical practicability,is convenient and simple to use.