Development and validation of a prognostic nomogram based on objective nutritional indexes in ischemic stroke patients with large vessel occlusion undergoing endovascular thrombectomy |
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| Institution: | 1. Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark;2. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark;3. Novartis Healthcare, Denmark;4. I2minds, Aarhus, Denmark;5. Danish Institute for Health Services Research, Copenhagen, Denmark;1. Association for Cardiac Research, Rome, Italy;2. EA 4650, Signalisation, électrophysiologie et imagerie des lésions d''ischémie reperfusion myocardique, UNICAEN, 14000 Caen, France;3. Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy;1. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK;2. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK;3. Central Finland Health Care District Hospital District, Department of Medicine, Finland District, Jyväskylä, Finland;4. Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK;5. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;6. Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland;1. Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C.Heymanslaan 10 - 4K3, 9000 Ghent, Belgium;2. Departments of Public Health Nutrition, Faculty of Public Health, Mulawarman University, Samarinda, East Kalimantan, Indonesia;3. Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre D''investigation Clinique, F-59000 Lille, France;4. Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE – Institute for Translational Research in Inflammation, F-59000 Lille, France;5. GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Science, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain;6. Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain;7. Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Spain;8. Instituto de Salud Carlos III, Madrid, Spain;1. Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea;2. Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea |
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| Abstract: | Background and aimsPreserved nutritional status in acute ischemic stroke patients with large vessel occlusion (LVO) undergoing endovascular thrombectomy (EVT) is important but lacks an effective evaluation method. We aimed to investigate the prognostic value of objective nutritional indexes (ONIs) in LVO patients after EVT that were validated by studies in patients with other vascular diseases receiving intervention therapy and to develop a functional prediction nomogram for better stroke management.Methods and resultsLVO patients undergoing EVT from 2016 to 2020 were retrospectively enrolled and randomly classified into training and validation cohorts at a ratio of 7:3. The ONIs, including the Controlling Nutritional Status (CONUT) score, Nutritional Risk Index (NRI), and Prognostic Nutritional Index (PNI), were calculated. A stepwise logistic regression model for 3-month poor functional outcome based on the smallest Akaike information criterion was employed to develop the nomogram, and the nomogram's determination and clinical use were tested by area under the curve (AUC), calibration plots, and decision curve analysis and compared with three earlier prognostic models. A total of 418 patients were enrolled. The CONUT independently related and increased the risk of 3-month poor functional outcome with an OR of 1.387 (95% CI: 1.133–1.698, p = 0.002). A nomogram including CONUT and other seven factors (AIC = 274.568) was developed. The AUC of the nomogram was 0.847 (95% CI: 0.799–0.894) and 0.836 (95% CI: 0.755–0.916) in the training and validation cohort, respectively, with better predictive performance and clinical utility than previous models.ConclusionThe CONUT independently related to the poor functional outcome, and the newly established nomogram reliably predicted the functional outcome in LVO patients after EVT. |
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| Keywords: | Malnutrition Objective nutritional indexes Ischemic stroke Large vessel occlusion Endovascular thrombectomy Prognosis Nomogram |
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