Screening of risk or protective factors for prognosis and their interaction in elderly patients with stroke

doi:10.16138/j.1673-6087.2025.04.06

Abstract

Abstract:

Objective To explore the risk or protective factors and their interactions for recurrence after acute ischemic stroke (AIS). Methods A total of 143 AIS patients admitted in our hospital from March 2020 to March 2023 were selected and followed up, and general clinical data were collected. Twelve patients were lost to follow-up. The end point of follow-up was stroke recurrence. The risk factors of stroke recurrence were screened by COX analysis, and the interaction between risk factors was analyzed. Results Univariate COX analysis showed that age, modified Rankin scale (mRS) score, the National Institutes of Health stroke scale (NIHSS) score, activated partial thrombin time and diabetes history were risk factors for poor prognosis in elderly patients with AIS [hazard ratio (HR) > 1, P < 0.05]. Montreal cognitive assessment scale (MoCA) score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1, P > 0.05). Multivariate COX analysis showed that mRS score and NIHSS score were independent risk factors for poor prognosis in elderly patients with AIS (HR > 1, P > 0.05). MoCA score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1, P > 0.05). Patients with high mRS score and high NIHSS score had worse prognosis (P < 0.001). Patients with high MoCA score and high fibrinogen level had better prognosis (P < 0.001). mRS score, NIHSS score, MoCA score and fibrinogen level had no significant interaction. Conclusions mRS score and NIHSS score are independent risk factors for poor prognosis in elderly patients with AIS. MoCA score and independent protective factor of good prognosis in elderly patients with AIS of fibrinogen. There was no significant interaction between these risk factors and protective factors.

Key words: Elderly, Acute ischemic stroke, Recurrence, Risk factor

CLC Number:

R541.75

XU Ting, RONG Jieli, GU Renli, XU Yang, LIU Xiaojiang. Screening of risk or protective factors for prognosis and their interaction in elderly patients with stroke[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(04): 296-300.

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变量	无复发组(n=89)	复发组(n=42)	t	P
年龄 (岁)	72.69±9.14	76.02±9.37	1.935	0.055
男性([n(%)]	49(55.06)	25(59.52)	0.232	0.630
吸烟史[n(%)]	31(34.83)	20(47.62)	1.963	0.161
饮酒史[n(%)]	37(41.57)	19(45.24)	0.157	0.692
糖尿病病史[n(%)]	35(39.33)	26(61.90)	5.846	0.016
高血压病史[n(%)]	37(41.57)	23(54.76)	1.999	0.157
高脂血症史[n(%)]	35(39.33)	14(33.33)	0.438	0.508
冠心病史[n(%)]	32(35.96)	16(38.10)	0.056	0.813
NIHSS评分 (分)	16.80±6.08	33.26±13.45	9.668	<0.001
MoCA评分 (分)	27.78±10.43	17.21±2.39	6.476	<0.001
mRS 评分 (分)	2.08±1.65	3.98±0.99	6.883	<0.001
凝血酶原时间 (s)	27.04±2.96	26.72±4.09	0.509	0.612
活化部分凝血酶时间 (s)	11.51±0.91	12.99±1.97	5.895	<0.001
纤维蛋白原 (g/L)	4.84±1.09	3.17±0.61	9.257	<0.001
发病至溶栓时间 (h)	3.10±0.54	3.00±0.97	0.757	0.450

变量	B	SE	Wald	P	HR	95%CI
变量	B	SE	Wald	P	HR	下限	上限
吸烟史	0.336	0.314	1.141	0.286	1.399	0.756	2.589
年龄	0.041	0.018	5.203	0.023	1.041	1.006	1.078
mRS评分	0.187	0.040	29.374	<0.001	1.206	0.745	1.871
MoCA评分	-0.127	0.029	18.660	<0.001	0.881	0.832	0.933
NIHSS评分	0.065	0.011	35.652	<0.001	1.068	1.045	1.091
发病至溶栓时间	-0.119	0.277	0.183	0.669	0.888	0.516	1.530
高血压病史	0.077	0.316	0.060	0.807	1.080	0.581	2.008
高脂血症	-0.482	0.337	2.050	0.152	0.618	0.319	1.195
冠心病	0.283	0.321	0.777	0.378	1.327	0.707	2.491
活化部分凝血酶时间	0.464	0.107	18.760	<0.001	1.590	1.289	1.962
凝血酶原时间	0.000	0.051	0.000	0.996	1.000	0.905	1.105
糖尿病病史	0.652	0.322	4.101	0.043	1.918	1.021	3.604
纤维蛋白原	-0.935	0.174	28.922	<0.001	0.393	0.279	0.552
性别	0.071	0.318	0.049	0.824	1.073	0.576	2.001
饮酒史	0.135	0.314	0.184	0.668	1.144	0.618	2.117

变量	B	SE	Wald	P	HR	95%CI
变量	B	SE	Wald	P	HR	下限	上限
mRS评分	0.183	0.041	6.541	0.011	1.201	0.832	1.976
MoCA评分	-0.137	0.050	7.479	0.006	0.872	0.791	0.962
NIHSS评分	0.035	0.014	6.629	0.010	1.036	1.009	1.064
活化部分凝血酶时间	0.147	0.100	2.129	0.145	1.158	0.951	1.410
糖尿病病史	0.577	0.357	2.616	0.106	1.781	0.885	3.584
纤维蛋白原	-0.439	0.190	5.333	0.021	0.644	0.444	0.936
年龄	0.211	0.147	3.391	0.149	1.113	0.547	1.883

变量	HR	95%CI		P
变量	HR	下限	上限	P
mRS评分*MoCA评分	1.364	0.885	1.774	0.320
mRS评分*NIHSS评分	1.012	0.607	1.401	0.457
mRS评分*纤维蛋白原	0.825	0.554	1.117	0.461
NIHSS评分*MoCA评分	1.750	0.975	1.456	0.342
NIHSS评分*纤维蛋白原	1.570	0.925	1.108	0.283
MoCA评分*纤维蛋白原	0.918	0.597	2.133	0.200