1
|
Hao F, Gao G, Guo Q, Liu S, Wang M, Chang Z, Wang H, Lu M, Liu S, Zou Z, Zhang Q, Wang X, Fu H, Li J, Han C, Duan L. Risk Factors for Massive Cerebral Infarction in Pediatric Patients With Moyamoya Disease. Pediatr Neurol 2024; 153:159-165. [PMID: 38394830 DOI: 10.1016/j.pediatrneurol.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND To explore the risk factors for preoperative massive cerebral infarction (MCI) in pediatric patients with moyamoya disease (MMD). METHODS Pediatric patients with MMD treated between 2017 and 2022 were enrolled. Logistic regression analysis was performed to identify risk factors for MCI among the patients, and a nomogram was constructed to identify potential predictors of MCI. Receiver operating characteristic (ROC) curves and areas under the curves were calculated to determine the effects of different risk factors. RESULTS This study included 308 pediatric patients with MMD, including 36 with MCI. The MCI group exhibited an earlier age of onset than the non-MCI group. Significant intergroup differences were observed in familial MMD history, postcirculation involvement, duration from diagnosis to initiation of treatment, Suzuki stage, magnetic resonance angiography (MRA) score, collateral circulation score, and RNF213 p.R4810K variations. Family history, higher MRA score, lower collateral circulation score, and RNF213 p.R4810K variations were substantial risk factors for MCI in pediatric patients with MMD. The nomogram demonstrated excellent discrimination and calibration capabilities. The integrated ROC model, which included all the abovementioned four variables, showed superior diagnostic precision with a sensitivity of 67.86%, specificity of 87.01%, and accuracy of 85.11%. CONCLUSIONS This study showed that family history, elevated MRA score, reduced collateral circulation score, and RNF213 p.R4810K variations are risk factors for MCI in pediatric patients with MMD. The synthesized model including these variables demonstrated superior predictive efficacy; thus, it can facilitate early identification of at-risk patients and timely initiation of appropriate interventions.
Collapse
Affiliation(s)
- Fangbin Hao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Gan Gao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qingbao Guo
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Simeng Liu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Minjie Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | | | - Hui Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Mingming Lu
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shitong Liu
- Chinese PLA Medical School, Beijing, China; Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhengxing Zou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaopeng Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China
| | - Heguan Fu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingjie Li
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Lian Duan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
2
|
Wu X, Xu Y, Wei M, Li M, Lei X, Yuan H, Guo J, Zhang Q, Zhang X, Sun M, Fan T, Luo G. Oral anticoagulants status after acute ischemic stroke and prognosis in patients with atrial fibrillation. J Stroke Cerebrovasc Dis 2024; 33:107452. [PMID: 37931484 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES To investigate the oral anticoagulants (OACs) use after acute ischemic stroke (AIS) and prognosis of patients with atrial fibrillation (AF). METHODS This was a real-world follow-up research of AIS patients with AF admitted to 5 hospitals in northwestern China. We visited these individuals every 6 months to check the type, dosage of OACs, and to record IS recurrence, bleeding, and death events and modified Rankin Scale (mRS) scores until December 2022. When one of the following occurring first was endpoint: IS recurrence, death or study end. Patients were divided into continuous anticoagulation group and non-continuous anticoagulation group based on whether they continued to take OACs from the moment they were discharged until the endpoint. We further analyzed the association between anticoagulation persistence and outcomes. RESULTS Among all 250 patients with OACs indication, 147 patients (58.8 %) received OACs at discharge. Only 37.9 % of patients (39/103) started OACs after discharge. Of the 147 patients treated with OACs, 21.8 % (32/147) discontinued anticoagulation after discharge. 239 of the 250 patients had completed the median 40-month follow-up with 91 patients in continuous anticoagulation group and 148 patients in non-continuous anticoagulation group. In the multivariate COX regression, non-continuous anticoagulation was an independent risk factor for poor prognosis (mRS>2) in AIS patients with AF (1.452[1.011, 2.086], p = 0.043). CONCLUSIONS This study revealed an upward trend in the use rate of OACs, but low OACs rates that meet guideline-based criteria and low anticoagulation persistence in AF patients after AIS in the northwestern China. Discontinuous anticoagulation was associated with an increased risk of poor prognosis in these patients.
Collapse
Affiliation(s)
- Xiaoyu Wu
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China; Atrial Fibrillation Centre and Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Yue Xu
- Department of Neurology, Ninth hospital of Xi'an, No. 151 East Section of South Second Ring Road, Xi'an 710054, China
| | - Meng Wei
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Mengmeng Li
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Xiangyu Lei
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Huijie Yuan
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Jing Guo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No.55 Xingshansi West Street, Xi'an 710061, China
| | - Qiang Zhang
- Department of Neurology, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an 710068, China
| | - Xiao Zhang
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Man Sun
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an 710004, China
| | - Tong Fan
- Department of Neurology, Xi'an Gaoxin Hospital, No. 16 Tuanjie South Road, Xi'an 710075, China
| | - Guogang Luo
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China.
| |
Collapse
|
3
|
Yang L, Huang X, Wang J, Yang X, Ding L, Li Z, Li J. Identifying stroke-related quantified evidence from electronic health records in real-world studies. Artif Intell Med 2023; 140:102552. [PMID: 37210153 DOI: 10.1016/j.artmed.2023.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Stroke is one of the leading causes of death and disability worldwide. The National Institutes of Health Stroke Scale (NIHSS) scores in electronic health records (EHRs), which quantitatively describe patients' neurological deficits in evidence-based treatment, are crucial in stroke-related clinical investigations. However, the free-text format and lack of standardization inhibit their effective use. Automatically extracting the scale scores from the clinical free text so that its potential value in real-world studies is realized has become an important goal. OBJECTIVE This study aims to develop an automated method to extract scale scores from the free text of EHRs. METHODS We propose a two-step pipeline method to identify NIHSS items and numerical scores and validate its feasibility using a freely accessible critical care database: MIMIC-III (Medical Information Mart for Intensive Care III). First, we utilize MIMIC-III to create an annotated corpus. Then, we investigate possible machine learning methods for two subtasks, NIHSS item and score recognition and item-score relation extraction. In the evaluation, we conduct both task-specific and end-to-end evaluations and compare our method with the rule-based method using precision, recall and F1 scores as evaluation metrics. RESULTS We use all available discharge summaries of stroke cases in MIMIC-III. The annotated NIHSS corpus contains 312 cases, 2929 scale items, 2774 scores and 2733 relations. The results show that the best F1-score of our method was 0.9006, which was attained by combining BERT-BiLSTM-CRF and Random Forest, and it outperformed the rule-based method (F1-score = 0.8098). In the end-to-end task, our method could successfully recognize the item "1b level of consciousness questions", the score "1" and their relation "('1b level of consciousness questions', '1', 'has value')" from the sentence "1b level of consciousness questions: said name = 1", while the rule-based method could not. CONCLUSIONS The two-step pipeline method we propose is an effective approach to identify NIHSS items, scores and their relations. With its help, clinical investigators can easily retrieve and access structured scale data, thereby supporting stroke-related real-world studies.
Collapse
Affiliation(s)
- Lin Yang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China; Key Laboratory of Medical Information Intelligent Technology, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Xiaoshuo Huang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China; School of Health Care Technology, Dalian Neusoft University of Information, Dalian 116023, China
| | - Jiayang Wang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lingling Ding
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiao Li
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China; Key Laboratory of Medical Information Intelligent Technology, Chinese Academy of Medical Sciences, Beijing 100020, China.
| |
Collapse
|