卒中相关性肺炎风险预测：初步列线图的开发与内部验证。

文献信息

中文摘要

背景： 卒中相关性肺炎（SAP）是急性卒中的常见并发症，凸显了早期风险识别的必要性。本研究旨在利用常规可获得的临床和血液学参数，开发并内部验证一个初步的SAP列线图。方法：这项单中心回顾性研究纳入650例患者，随机分为训练队列（n=454）和内部验证队列（n=196）。基线血样在入院24小时内且SAP发生前获取；结局为卒中发病后7天内的SAP。采用最小绝对收缩和选择算子（LASSO）回归，随后进行多变量logistic回归，以选择预测因子并构建列线图。结果：190例患者（29.2%）发生SAP。年龄较大、心房颤动、较高的白细胞计数、较低的淋巴细胞百分比和较低的血红蛋白与SAP独立相关。训练队列的受试者工作特征曲线下面积（AUC）为0.772，内部验证队列为0.738，相应的95%置信区间分别为0.723-0.820和0.662-0.815。乐观校正后的训练AUC为0.762。验证Brier评分为0.181，决策曲线分析提示潜在的临床净获益。结论：这个初步列线图可能支持早期SAP风险分层。然而，单中心回顾性设计以及遗漏关键神经预测因子（包括卒中严重程度和吞咽困难），需要在临床实施前进行前瞻性多中心验证。

英文摘要

Stroke-associated pneumonia (SAP) is a common complication of acute stroke, highlighting the need for early risk identification. This study aimed to develop and internally validate a preliminary SAP nomogram using routinely available clinical and hematological parameters. This single-center retrospective study included 650 patients randomly divided into training (n = 454) and internal validation (n = 196) cohorts. Baseline blood samples were obtained within 24 hours of admission and before SAP onset; the outcome was SAP within 7 days of stroke onset. Least absolute shrinkage and selection operator (LASSO) regression followed by multivariable logistic regression was used to select predictors and construct the nomogram. SAP occurred in 190 patients (29.2%). Older age, atrial fibrillation, higher white blood cell count, lower lymphocyte percentage, and lower hemoglobin were independently associated with SAP. The area under the receiver operating characteristic curve (AUC) was 0.772 in the training cohort and 0.738 in the internal validation cohort, with respective 95% confidence intervals of 0.723-0.820 and 0.662-0.815. The optimism-corrected training AUC was 0.762. The validation Brier score was 0.181, and decision curve analysis suggested potential clinical net benefit. This preliminary nomogram may support early SAP risk stratification. However, the single-center retrospective design and omission of key neurological predictors, including stroke severity and dysphagia, necessitate prospective multicenter validation before clinical implementation.