那不勒斯预后评分对急性前循环大血管闭塞性脑卒中首过成功取栓患者90天不良预后的预测价值

Predictive Value of the Naples Prognostic Score for 90-Day Poor Outcome after First-Pass Successful Recanalization in Anterior Circulation Large Vessel Occlusion

摘要: 目的：探讨那不勒斯预后评分(Naples Prognostic Score, NPS)对前循环大血管闭塞急性缺血性卒中首过成功取栓患者90天不良预后的预测价值，并与中性粒细胞/淋巴细胞比值(Neutrophil-to-Lymphocyte Ratio, NLR)进行比较，以明确NPS是否不劣于NLR。方法：回顾性连续纳入2021年1月至2025年12月于沧州市人民医院行机械取栓并首次再通(mTICI 2c/3级)的前循环大血管闭塞患者。采集入院时一般资料及首次实验室指标，依90天mRS评分分为预后良好与预后不良两组。采用多因素Logistic回归分析预后独立影响因素。绘制受试者工作特征(ROC)曲线比较NPS与NLR的预测效能；最佳截断值通过约登指数确定。基于嵌套模型比较计算净重新分类指数(Net Reclassification Index, NRI)和综合判别改善指数(Integrated Discrimination Improvement, IDI)，以量化NPS的增量预测价值。结果：118例患者中，预后良好组74例(62.7%)，预后不良组44例(37.3%)。多因素Logistic回归显示，NPS (OR = 2.52, 95% CI: 1.45~4.79, P = 0.002)及NLR均为90天不良预后的独立危险因素。ROC分析显示，NPS的AUC为0.700 (95% CI: 0.606~0.793)，NLR的AUC为0.656 (95% CI: 0.555~0.756)，两者差异无统计学意义(Z = 0.969, P = 0.332)，提示NPS的预测能力不劣于NLR。NPS的最佳截断值为2.5 (即NPS ≥ 3分)，敏感度为77.3%，特异度为59.5%。多截断点分析显示，NPS ≥ 4分时特异度可达89.2%。嵌套模型比较显示，在传统因素基础上加入NPS后AUC从0.801提升至0.839，NRI为0.041，IDI为0.0553。结论：NPS ≥ 3分是首过成功取栓后90天不良预后的独立预测指标，其预测价值不劣于NLR (AUC: 0.700 vs 0.656, P = 0.332)，且效应量更大、评分更简便，可作为临床早期风险分层的实用工具。

Abstract: Objective: To evaluate the predictive value of the Naples Prognostic Score (NPS) for 90-day poor outcome in patients with anterior circulation large vessel occlusion who achieved first-pass successful recanalization after mechanical thrombectomy, and to compare it with the neutrophil-to-lymphocyte ratio (NLR), so as to determine whether NPS is non-inferior to NLR. Methods: Patients with anterior circulation large vessel occlusion who underwent mechanical thrombectomy and achieved first-pass recanalization (mTICI 2c/3) between January 2021 and December 2025 at Cangzhou People’s Hospital were retrospectively enrolled. General data and initial laboratory parameters on admission were collected. Patients were divided into favorable and poor outcome groups based on the 90-day modified Rankin Scale score. Multivariable logistic regression was used to identify independent factors influencing prognosis. Receiver operating characteristic (ROC) curves were plotted to compare the predictive performance of NPS and NLR; the optimal cut-off value was determined by the Youden index. In addition, the net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated based on nested model comparisons to quantify the incremental predictive value of NPS. Results: Among the 118 patients, 74 (62.7%) had favorable outcomes and 44 (37.3%) had poor outcomes. Multivariable logistic regression showed that NPS (OR = 2.52, 95% CI: 1.45~4.79, P = 0.002) and NLR (OR = 1.15, 95% CI: 1.01~1.32, P = 0.043) were independent risk factors for 90-day poor outcome. ROC analysis demonstrated an AUC of 0.700 (95% CI: 0.606~0.793) for NPS and 0.656 (95% CI: 0.555~0.756) for NLR, with no significant difference between the two (Z = 0.969, P = 0.332), suggesting that NPS was non-inferior to NLR. The optimal cut-off value for NPS was 2.5 (i.e., NPS ≥ 3), yielding a sensitivity of 77.3% and a specificity of 59.5%. Multi-cutoff analysis showed that the specificity reached 89.2% at NPS ≥ 4. Nested model comparisons revealed that the addition of NPS to traditional factors improved the AUC from 0.801 to 0.839, with an NRI of 0.041 and an IDI of 0.0553. Conclusion: NPS ≥ 3 is an independent predictor of 90-day poor outcome after first-pass successful recanalization, with predictive value non-inferior to NLR (AUC: 0.700 vs. 0.656, P = 0.332). It offers a larger effect size and a simpler scoring system, and may serve as a practical tool for early clinical risk stratification.