RRE-90、ESRS和SPI-Ⅱ评分对缺血性脑卒中复发风险预测价值比较
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摘要
目的:比较90 d复发风险评估量表(RRE-90)、ESSEN卒中风险评估量表(ESRS)和卒中预测工具-Ⅱ(SPI-Ⅱ)量表对缺血性脑卒中患者卒中复发的预测价值。方法:前瞻性连续纳入诊治的急性缺血性脑卒中患者,全面收集患者的临床资料。住院期间对患者进行RRE-90、ESRS和SPI-Ⅱ量表评分。患者出院后1月、3月、6月及1年时进行随访,记录卒中复发情况。计算各个随访点三种评分受试者工作曲线下面积(AUC),对比三种量表预测卒中复发的效能。结果:排除基线不全、失访等患者后,研究最终纳入患者471例。1年随访结束时,卒中复发40例,累计复发率为8.75%。对比各随访点RRE-90、ESRS和SPI-Ⅱ评分的AUC发现,随访1月、3月时RRE-90预测效能优于ESRS和SPI-Ⅱ(P<0.05),1年时ESRS和SPI-Ⅱ预测效能则优于RRE-90(P<0.05)。ESRS与SPI-Ⅱ预测效能类似(P>0.05)。结论:应用RRE-90、ESRS和SPI-Ⅱ量表均能预测卒中复发。RRE-90对卒中短期复发预测效果优于ESRS和SPI-Ⅱ量表,ESRS和SPI-Ⅱ量表对卒中复发预测效能效果相近,且在预测卒中长期复发上二者均优于RRE-90。
Objective: To compare the predictive value of 90-day Recurrence Risk Estimator(RRE-90), the ESSEN Stroke Risk Score(ESRS) and the Stroke Prognostic Instrument Ⅱ(SPI-Ⅱ) for recurrent risk in patients with ischemic stroke.Methods: Patients with acute ischemic stroke were prospectively enrolled. The clinical data about the patients were collected. RRE-90, ESRS and SPI-Ⅱ scales were assessed during hospitalization. All the patients were followed up at 1 month, 3 months, 6 months, and 1 year after discharge and stroke recurrence was recorded.The area under the curve(AUC) of the three scores at each follow-up point was calculated and to compare the predictive efficacy of the three scales for stroke recurrence.Results: After exclusion of patients with incomplete baseline data and loss of follow-up, 471 patients were eventually included in the study. At the end of the 1-year follow-up, there were 40 patients stroke reoccurred and the cumulative stroke recurrent rate was 8.75%. Compared with the AUC of RRE-90, ESRS and SPI-Ⅱ scores at each follow-up point, the predictive value of RRE-90 was superior to that of ESRS and SPI-Ⅱ at 1-and 3-month follow-up(P<0.05), and the predictive value of ESRS and SPI-Ⅱ was better than that of RRE-90 at 1-year follow-up(P<0.05). The predictive value between ESRS and SPI-Ⅱ was similar(P>0.05).Conclusions: All of RRE-90, ESRS and SPI-Ⅱ scales can predict stroke recurrence. RRE-90 is superior to the ESRS and SPI-Ⅱ scales in predicting short-term stroke recurrence. The ESRS and SPI-Ⅱ scales have similar efficacy in predicting stroke recurrence and both are superior to RRE-90 in predicting long-term stroke recurrence.
Objective: To compare the predictive value of 90-day Recurrence Risk Estimator(RRE-90), the ESSEN Stroke Risk Score(ESRS) and the Stroke Prognostic Instrument Ⅱ(SPI-Ⅱ) for recurrent risk in patients with ischemic stroke.Methods: Patients with acute ischemic stroke were prospectively enrolled. The clinical data about the patients were collected. RRE-90, ESRS and SPI-Ⅱ scales were assessed during hospitalization. All the patients were followed up at 1 month, 3 months, 6 months, and 1 year after discharge and stroke recurrence was recorded.The area under the curve(AUC) of the three scores at each follow-up point was calculated and to compare the predictive efficacy of the three scales for stroke recurrence.Results: After exclusion of patients with incomplete baseline data and loss of follow-up, 471 patients were eventually included in the study. At the end of the 1-year follow-up, there were 40 patients stroke reoccurred and the cumulative stroke recurrent rate was 8.75%. Compared with the AUC of RRE-90, ESRS and SPI-Ⅱ scores at each follow-up point, the predictive value of RRE-90 was superior to that of ESRS and SPI-Ⅱ at 1-and 3-month follow-up(P<0.05), and the predictive value of ESRS and SPI-Ⅱ was better than that of RRE-90 at 1-year follow-up(P<0.05). The predictive value between ESRS and SPI-Ⅱ was similar(P>0.05).Conclusions: All of RRE-90, ESRS and SPI-Ⅱ scales can predict stroke recurrence. RRE-90 is superior to the ESRS and SPI-Ⅱ scales in predicting short-term stroke recurrence. The ESRS and SPI-Ⅱ scales have similar efficacy in predicting stroke recurrence and both are superior to RRE-90 in predicting long-term stroke recurrence.
引文
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[10] Meng X,Wang Y,Zhao X,et al.Validation of the essen stroke risk score and the stroke prognosis instrument II in Chinese patients[J].Stroke,2011,42(12):3619-3620.
[11] Wang Z,Li J,Wang C,et al.Gender differences in 1-year clinical characteristics and outcomes after stroke:results from the China National Stroke Registry[J].PloS One,2013,8(2):e56459.
[12] Maier IL,Bauerle M,Kermer P,et al.Risk prediction of very early recurrence,death and progression after acute ischaemic stroke[J].Eur J Neurol,2013,20(4):599-604.
[13] Elkind MS.Outcomes after stroke:risk of recurrent ischemic stroke and other events[J].The American Journal of Medicine,2009,122(4 Suppl 2):S7-S13.
[14] Arsava EM,Furie KL,Schwamm LH,et al.Prediction of early stroke risk in transient symptoms with infarction:relevance to the new tissue-based definition[J].Stroke,2011,42(8):2186-2190.
[15] Oza R,Rundell K,Garcellano M.Recurrent ischemic stroke:strategies for prevention[J].American Family Physician,2017,96(7):436-440.
[16] 焉双梅,洪渊,张欢,等.ESRS和SPI-Ⅱ评分对急性缺血性脑卒中患者复发风险的评估作用[J].中风与神经疾病杂志,2016,33(11):1002-1005.
[17] Weimar C,Benemann J,Michalski D,et al.Prediction of recurrent stroke and vascular death in patients with transient ischemic attack or nondisabling stroke:a prospective comparison of validated prognostic scores[J].Stroke,2010,41(3):487-493.
[2] 李筱婷,何剑波,翟洁敏.卒中单元治疗脑卒中患者复发危险因素分析[J].陕西医学杂志,2013,42(8):966-968.
[3] Park JH,Ovbiagele B.Relationship of functional disability after a recent stroke with recurrent stroke risk[J].Eur J Neurol,2016,23(2):361-367.
[4] The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease):a major international collaboration.WHO MONICA Project Principal Investigators[J].Journal of Clinical Epidemiology,1988,41(2):105-114.
[5] Hankey GJ.Secondary stroke prevention[J].The Lancet Neurology,2014,13(2):178-194.
[6] Arsava EM,Kim GM,Oliveira-Filho J,et al.Prediction of early recurrence after acute ischemic stroke[J].JAMA Neurol,2016,73(4):396-401.
[7] Pendlebury ST,Rothwell PM.Risk of recurrent stroke,other vascular events and dementia after transient ischaemic attack and stroke[J].Cerebrovasc Dis,2009,27(Suppl 3):1-11.
[8] Callaly E,Ni Chroinin D,Hannon N,et al.Rates,predictors,and outcomes of early and late recurrence after stroke:The north dublin population stroke study[J].Stroke,2016,47(1):244-246.
[9] Feng W,Hendry RM,Adams RJ.Risk of recurrent stroke,myocardial infarction,or death in hospitalized stroke patients[J].Neurology,2010,74(7):588-593.
[10] Meng X,Wang Y,Zhao X,et al.Validation of the essen stroke risk score and the stroke prognosis instrument II in Chinese patients[J].Stroke,2011,42(12):3619-3620.
[11] Wang Z,Li J,Wang C,et al.Gender differences in 1-year clinical characteristics and outcomes after stroke:results from the China National Stroke Registry[J].PloS One,2013,8(2):e56459.
[12] Maier IL,Bauerle M,Kermer P,et al.Risk prediction of very early recurrence,death and progression after acute ischaemic stroke[J].Eur J Neurol,2013,20(4):599-604.
[13] Elkind MS.Outcomes after stroke:risk of recurrent ischemic stroke and other events[J].The American Journal of Medicine,2009,122(4 Suppl 2):S7-S13.
[14] Arsava EM,Furie KL,Schwamm LH,et al.Prediction of early stroke risk in transient symptoms with infarction:relevance to the new tissue-based definition[J].Stroke,2011,42(8):2186-2190.
[15] Oza R,Rundell K,Garcellano M.Recurrent ischemic stroke:strategies for prevention[J].American Family Physician,2017,96(7):436-440.
[16] 焉双梅,洪渊,张欢,等.ESRS和SPI-Ⅱ评分对急性缺血性脑卒中患者复发风险的评估作用[J].中风与神经疾病杂志,2016,33(11):1002-1005.
[17] Weimar C,Benemann J,Michalski D,et al.Prediction of recurrent stroke and vascular death in patients with transient ischemic attack or nondisabling stroke:a prospective comparison of validated prognostic scores[J].Stroke,2010,41(3):487-493.