Hsu Hsien-Ta, Chen Pei-Ya, Tzeng I-Shiang, Hsu Po-Jen, Lin Shinn-Kuang
Division of Neurosurgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan.
School of Medicine, Tzu Chi University, Hualien 97004, Taiwan.
Diagnostics (Basel). 2022 Mar 2;12(3):622. doi: 10.3390/diagnostics12030622.
(1) Background: We investigated the association of four immune-inflammatory markers with clinical features and established location-specific nomograms to predict mortality risk in patients with intracerebral hemorrhage (ICH). (2) Methods: We retrospectively enrolled 613 inpatients with acute ICH. (3) Results: Overall mortality was 22%, which was highest in pontine hemorrhage and lowest in thalamic hemorrhage. All four immune-inflammatory markers exhibited a positive linear correlation with glucose, ICH volume, ICH score, and discharge Modified Rankin Scale (mRS) score. Significant predictors of death due to lobar/putaminal hemorrhage were age, glucose and creatinine levels, initial Glasgow Coma Scale (GCS) score, ICH volume, and presence of intraventricular hemorrhage. None of the immune-inflammatory markers were significant predictors of unfavorable outcome or death. We selected significant factors to establish nomograms for predicting death due to lobar/putaminal, thalamic, pontine, and cerebellar hemorrhages. The C-statistic for predicting death in model I (comprising factors in the establishment of the nomogram) in each type of ICH was higher than that in model II (comprising ICH score alone), except for cerebellar hemorrhage. These nomograms for predicting death had good discrimination (C-index: 0.889 to 0.975) and prediction probabilities (C-index: 0.890 to 0.965). (4) Conclusions: Higher immune-inflammatory markers were associated with larger ICH volume, worse initial GCS, and unfavorable outcomes, but were not independent prognostic predictors. The location-specific nomograms provided novel and accurate models for predicting mortality risk.
(1) 背景:我们研究了四种免疫炎症标志物与临床特征的关联,并建立了特定部位的列线图以预测脑出血(ICH)患者的死亡风险。(2) 方法:我们回顾性纳入了613例急性ICH住院患者。(3) 结果:总体死亡率为22%,桥脑出血的死亡率最高,丘脑出血的死亡率最低。所有四种免疫炎症标志物与血糖、ICH体积、ICH评分及出院时改良Rankin量表(mRS)评分均呈正线性相关。叶/壳核出血导致死亡的显著预测因素为年龄、血糖和肌酐水平、初始格拉斯哥昏迷量表(GCS)评分、ICH体积及脑室内出血的存在。没有一种免疫炎症标志物是不良结局或死亡的显著预测因素。我们选择显著因素建立了用于预测叶/壳核、丘脑、桥脑和小脑出血导致死亡的列线图。除小脑出血外,每种类型ICH的模型I(包含列线图建立中的因素)预测死亡的C统计量均高于模型II(仅包含ICH评分)。这些预测死亡的列线图具有良好的区分度(C指数:0.889至0.975)和预测概率(C指数:0.890至0.965)。(4) 结论:较高的免疫炎症标志物与较大的ICH体积、较差的初始GCS及不良结局相关,但不是独立的预后预测因素。特定部位的列线图为预测死亡风险提供了新颖且准确的模型。