Predictors of death within 6 months of stroke onset: A model with Barthel index, platelet/lymphocyte ratio and serum albumin

Abstract

Abstract Aims To develop and internally validate a nomogram to predict the risk of death within 6 months of onset of stroke in Chinese. Identifying risk factors with potentially direct effects on the nomogram will improve the quality of risk assessment and help nurses implement preventive measures based on patient‐specific risk factors. Design A retrospective study. Methods We performed a least absolute shrinkage and selection operator (LASSO) regression modelling and multivariate logistic regression analysis to establish a prediction model of death risk in stroke patients within 6 months of onset. LASSO and time‐dependent Cox regression models were further used to analyse the 6‐month survival of stroke patients. Data were collected from 21 October 2013–6 May 2019. Results The independent predictors of the nomogram were Barthel index (odds ratio (OR) = 0.980, 95% confidence interval (CI) = 0.961–0.998, p = .03), platelet/lymphocyte ratio (OR = 1.005, 95% CI = 1.000–1.010, p = .04) and serum albumin (OR = 0.854, 95% CI = 0.774–0.931, p < .01). This model showed good discrimination and consistency, and its discrimination evaluation C‐statistic was 0.879 in the training set and 0.891 in the internal validation set. The DCA indicated that the nomogram had a higher overall net benefit over most of the threshold probability range. The time‐dependent Cox regression model established the impact of the time effect of the age variable on survival time. Conclusions Our results identified three predictors of death within 6 months of stroke in Chinese. These predictors can be used as risk assessment indicators to help caregivers performing clinical nursing work, and in clinical practice, it is suggested that nurses should evaluate the self‐care ability of stroke patients in detail. The constructed nomogram can help identify patients at high risk of death within 6 months, so that intervention can be performed as early as possible.

Keywords

• Barthel index
• nomogram
• nursing
• PLR
• prediction model
• serum albumin