Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok'ou District, Wuhan, 430030, Hubei, China.
BMC Neurol. 2023 Jan 6;23(1):6. doi: 10.1186/s12883-022-03039-9.
Intracerebral hemorrhage (ICH) is the second most common subtype of stroke, with high mortality and morbidity. At present, there are no effective 6-month prognostic markers, particularly for younger patients. The aim of this research was to construct a new valuable prognostic nomogram model incorporating haemoglobin levels for adult patients with ICH.
Patients aged between 18 and 50 presenting with intracerebral haemorrhage at the Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between January 1st 2012 and December 31st 2018 were included in this retrospective study. Independent factors of prognosis were identified by univariate and multivariate logistic regression analyses, and a new nomogram model was constructed and validated. The clinical value of the nomogram model was subsequently explored utilizing decision curve analysis and clinical impact curves.
In total, 565 patients were enrolled in this study, 117 (20.7%) of whom developed an unfavourable prognosis. Infratentorial lesion (adjusted odds ratio [aOR] = 3.708, 95% confidence interval [CI], 1.490-9.227; P = 0.005) was the most significant unfavourable outcome. Age ([aOR] = 1.054; 95% CI, 1.014-1.096; P = 0.008), hematoma volume (aOR = 1.014, 95% CI, 1.002-1.027; P = 0.024), haemoglobin (aOR = 0.981, 95% CI, 0.969-0.993; P = 0.002), blood glucose (aOR = 1.135, 95% CI, 1.037-1.241; P = 0.005) and NIHSS (aOR = 1.105, 95% CI, 1.069-1.141; P < 0.001) were independent risk factors. Based on these 6 factors, the nomogram can be employed to predict early functional prognosis with high accuracy (AUC 0.791). Decision curve analysis and clinical impact curves showed an increased net benefit for utilizing the nomogram.
The haemoglobin level at admission may be an easily overlooked factor in clinical work. This new nomogram model could be a promising and convenient tool to predict the early functional prognosis of adults with ICH. More prospective multicentre studies are needed to validate these findings.
脑出血（ICH）是中风的第二大亚型，具有较高的死亡率和发病率。目前，尚无有效的 6 个月预后标志物，特别是对于年轻患者。本研究旨在建立一个新的有价值的包含血红蛋白水平的成年 ICH 患者预后列线图模型。
本回顾性研究纳入了 2012 年 1 月 1 日至 2018 年 12 月 31 日期间在华中科技大学同济医学院附属同济医院就诊的年龄在 18 至 50 岁之间的颅内出血患者。通过单因素和多因素逻辑回归分析确定预后的独立因素，并构建和验证新的列线图模型。随后利用决策曲线分析和临床影响曲线探讨了该列线图模型的临床价值。
本研究共纳入了 565 名患者，其中 117 名（20.7%）预后不良。幕下病变（调整优势比[aOR] = 3.708，95%置信区间[CI]：1.490-9.227；P = 0.005）是最显著的不良结局。年龄[aOR] = 1.054；95%CI：1.014-1.096；P = 0.008）、血肿体积[aOR] = 1.014，95%CI：1.002-1.027；P = 0.024）、血红蛋白[aOR] = 0.981，95%CI：0.969-0.993；P = 0.002）、血糖[aOR] = 1.135，95%CI：1.037-1.241；P = 0.005）和 NIHSS[aOR] = 1.105，95%CI：1.069-1.141；P < 0.001）是独立的危险因素。基于这 6 个因素，该列线图可以高度准确地预测早期功能预后（AUC 0.791）。决策曲线分析和临床影响曲线表明，使用该列线图可带来更大的净收益。
血红蛋白水平在入院时可能是临床工作中容易被忽视的因素。这个新的列线图模型可能是预测成人 ICH 早期功能预后的一种有前途且方便的工具。需要更多的前瞻性多中心研究来验证这些发现。
