Analysis of Factors Affecting Occult Cancer in Patients with Acute Ischemic Stroke and Development of a Predictive Model

GAO Zhongsheng; WANG Xiaoyan

doi:10.3639/j.issn.2095-3097.2024.11.032

Abstract：Objective To analyze the factors influencing occult cancer(OCC)in patients with acute ischemic stroke(AIS)and develop a predictive model.Methods A total of 150 AIS patients with OCC were selected as the OCC group,and AIS patients without OCC,selected in a 1:1 ratio,were selected as the non-OCC group.Clinical data of all patients were col-lected.LASSO regression was used to screen for factors influencing OCC in AIS patients,and multivariate conditional logistic regression was applied to identify independent influencing factors.The prediction model was developed using RStudio software,with the concordance index assessing the model's discriminative ability,the calibration curve evaluating model accuracy,the decision curve analyzing clinical benefit,the Hosmer-Lemeshow test assessing model fit,and the receiver operating character-istic(ROC)curve analyzing predictive performance.Results Multivariate conditional logistic regression analysis identified stroke of undetermined etiology,multiple vascular territory infarctions,elevated D-dimer(D-D),and high fibrinogen(FIB)as independent risk factors for OCC in AIS patients,while hypertension and elevated hemoglobin were independent protective fac-tors(P<0.05).A predictive model was constructed based on these independent influencing factors,with a concordance index of 0.894.The calibration curve closely aligned with the ideal curve,and the decision curve was superior to the two extreme curves.The Hosmer-Lemeshow test yielded P>0.05.The ROC curve indicated that the area under the curve(AUC)for predicting OCC in AIS patients was 0.894.Conclusion Stroke of undetermined etiology,multiple vascular territory infarctions,hypertension,D-D,FIB,and hemoglobin are independent influencing factors for OCC in AIS patients.The developed predic-tion model demonstrates high predictive efficacy.