Development and validation of a risk stratification model for stroke recurrence after acute ischemic stroke in young adults: A nomogram-based, multicenter retrospective study

Abstract

Objective

The prevalence of ischemic stroke in young adults has increased dramatically. However, factors associated with prognosis in this cohort have not been well studied. This study primary aimed to construct and validate a nomogram for predicting stroke recurrence and to achieve risk stratification of young adults after acute ischemic stroke (AIS).

Methods

In this retrospective, multicenter study, we identified AIS patients aged 18–50 years in Tianjin Huanhu Hospital (training cohort) and The Affiliated Hospital of Chengde Medical College (validation cohort) from September 2019 to September 2021, respectively. Demographics and clinical characteristics data were systematically collected. A stepwise Cox proportional hazards regression analysis was used to identify the independent predictors of stroke recurrence in the training cohort and employed to construct the best-fit nomogram. Patients were stratified into low-, medium-, and high-risk groups based on the total points. Receiver operating characteristic (ROC) analysis and calibration curves were used to assess the discrimination and calibration of the nomogram. The discriminate value of risk stratification was verified using Kaplan-Meier curves, and external validation was performed with the validation cohort.

Results

A total of 467 young adult AIS patients were enrolled in this study. The overall prevalence of young adults in AIS patients was 13.3 % (95 % confidence interval, 12.2 %-14.5 %). Hyperlipidemia (Hazard ratio, 2.4 [1.2–4.9]), current smoking (5.9 [2.7–12.8]), stroke subtype (small-vessel occlusion, 3.7 [1.8–7.6]; stroke of undetermined cause/ others, 14.5 [3.0–70.2]), and stenosis (11.4 [4.5–28.9]) were significant independent predictors of stroke recurrence. A nomogram was constructed with the above predictors and achieved a satisfactory prediction in the validation cohort. Patients were classified into low-, medium-, and high-risk groups based on the total points with the cutoff value of 110.8 and 185.2. The log-rank test showed significant discrimination among the Kaplan-Meier curves of different risk groups (P < 0.001).

Conclusion

The nomogram can satisfactory prediction of stroke recurrence-free rate in young adult patients and achieved risk stratification, may help to personalize management of patients.