老年急性缺血性卒中患者衰弱指数、营养风险与静脉溶栓后院内感染风险的相关性分析及预测模型构建OA

Objective To analyze the correlation between frailty index,nutritional risk,and the risk of post-stroke nosocomial infection in elderly patients with acute ischemic stroke(AIS),and to construct a risk prediction model. Methods This prospective observational study enrolled elderly patients(≥ 60 years)with AIS who were admitted to the Department of Neurology of Wuhan No.1 Hospital and received intravenous thrombolysis between January 2022 and December 2024.Patients were divided into an infection group and a non-infection group based on the occurrence of nosocomial infection after intravenous thrombolysis.Differences in general clinical data,characteristics on admission,treatment-related features,pre-treatment frailty status,nutritional risk,and inflammatory factor levels were compared between the two groups.Multivariate logistic regression analysis was used to identify independent risk factors associated with infection in elderly AIS patients and to construct a prediction model.The predictive performance of the model for infection was evaluated using the ROC curve analysis. Results A total of 201 elderly AIS patients were enrolled,with an age range of 60-76 years and a mean age of(66.3±3.3)years.The infection group comprised 68 patients(infection rate 33.8％),and the non-infection group comprised 133 patients.Compared to the non-infection group,the infection group had significantly higher values for the following parameters(P＜0.05):onset-to-needle time,age,proportion of patients with diabetes mellitus history,NIHSS score on admission,proportion with conscious disturbance,pre-treatment frailty index,proportion of frail patients,nutritional risk screening 2002(NRS 2002)score,proportion of nutritional risk,and levels of C-reactive protein,procalcitonin,and IL-6.Multivariate logistic regression analysis identified the following as independent risk factors for nosocomial infection in elderly AIS patients:high frailty index(OR 5.812,95％CI 1.959-35.207,P=0.015),high NRS 2002 score(OR 1.370,95％CI 1.106-1.696,P=0.004),high procalcitonin level(OR 25.358,95％CI3.074-209.209,P=0.003),and high IL-6 level(OR 1.052,95％CI 1.009-1.098,P=0.017).ROC curve analysis indicated that the prediction model,constructed based on these four factors,had an AUC of 0.834(95％CI0.771-0.896),with a sensitivity of 79.03％and a specificity of 81.00％,indicating good predictive performance. Conclusions A significant correlation exists between pre-thrombolysis frailty status,nutritional risk,and the risk of post-stroke nosocomial infection in elderly patients with AIS.The prediction model based on frailty index,nutritional risk score,and inflammatory factors shows high predictive efficacy for nosocomial infection risk in these patients.