Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Neurological Sciences
Published in: Neurological Sciences 4/2022

01-04-2022 | Original Article

Construction of a nomogram to reveal the prognostic benefit of spontaneous intracranial hemorrhage among Chinese adults: a population-based study

Authors: Gui-Jun Zhang, Jie-Yi Zhao, Tao Zhang, Chao You, Xiao-Yu Wang

Published in: Neurological Sciences | Issue 4/2022

Login to get access

Abstract

Background and purpose

We aimed to build a nomogram, based on patients with spontaneous intracerebral hemorrhage (SICH), to predict the probability of mortality and morbidity at 7 days and 90 days, respectively.

Methods

We performed a retrospective study, with patients at less than 6 h from ictus admitted to the department of neurosurgery in a single institute, from January 2011 to December 2018. A total of 1036 patients with SICH were included, 486 patients (46.9%) were 47–66 years old at diagnosis, and 711 patients (68.6%) were male. The least absolute shrinkage and section operator method was performed to identify the key adverse factors predicting the outcomes in patients with SICH, and multivariate logistic regression analysis was built on these variables, and then the results were visualized by a nomogram. The discrimination of the prognostic models was measured and compared by means of Harrell’s concordance index (C-index), calibration curve, area under the curve (AUC), and decision curve analysis (DCA).

Results

Multivariate logistic regression analysis revealed that factors affecting 7-day mortality, including the following: age, therapy, Glasgow Coma Scale (GCS) admission, location, ventricle involved, hematoma volume, white blood cell (WBC), uric acid (UA), and l-lactic dehydrogenase (LDH); and factors affecting 90-day mortality, including temperature, therapy, GCS admission, ventricle involved, WBC, international normalized ratio, UA, LDH, and systolic blood pressure. The C-index for the 7-day mortality and 90-day mortality prediction nomogram was 0.9239 (95% CI = 0.9061–0.9416) and 0.9241 (95% CI = 0.9064–0.9418), respectively. The AUC of 7-day mortality was 92.4, as is true of 90-day mortality. The calibration curve and DCA indicated that nomograms in our study had a good prediction ability. For 90-day morbidity, age, marital status, and GCS at 7-day remained statistically significant in multivariate analysis. The C-index for the prediction nomogram was 0.6898 (95% CI = 0.6511–0.7285), and the calibration curve, AUC as well as DCA curve indicated that the nomogram for the prediction of good outcome demonstrated good agreement in this cohort.

Conclusions

Nomograms in this study revealed many novel prognostic demographic and laboratory factors, and the individualized quantitative risk estimation by this model would be more practical for treatment management and patient counseling.
Literature
1.
Zhou M, Wang H, Zeng X et al (2019) Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 394(10204):1145–1158CrossRef
2.
Hemphill JR, Greenberg SM, Anderson CS et al (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(7):2032–2060CrossRef
3.
Sacco S, Marini C, Toni D et al (2009) Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 40(2):394–399CrossRef
4.
O’Donnell MJ, Chin SL, Rangarajan S et al (2016) Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 388(10046):761–775CrossRef
5.
Hansen BM, Nilsson OG, Anderson H et al (2013) Long term (13 years) prognosis after primary intracerebral haemorrhage: a prospective population based study of long term mortality, prognostic factors and causes of death. J Neurol Neurosurg Psychiatry 84(10):1150–1155CrossRef
6.
Selim M, Sheth KN (2015) Perihematoma edema: a potential translational target in intracerebral hemorrhage? Transl Stroke Res 6(2):104–106CrossRef
7.
Murthy SB, Moradiya Y, Dawson J et al (2015) Perihematomal edema and functional outcomes in intracerebral hemorrhage: influence of hematoma volume and location. Stroke 46(11):3088–3092CrossRef
8.
Yang J, Arima H, Wu G et al (2015) Prognostic significance of perihematomal edema in acute intracerebral hemorrhage: pooled analysis from the intensive blood pressure reduction in acute cerebral hemorrhage trial studies. Stroke 46(4):1009–1013CrossRef
9.
Fischer U, Cooney MT, Bull LM et al (2014) Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study. Lancet Neurol 13(4):374–384CrossRef
10.
Parry-Jones AR, Paley L, Bray BD et al (2016) Care-limiting decisions in acute stroke and association with survival: analyses of UK national quality register data. Int J Stroke 11(3):321–331CrossRef
11.
Al-Shahi SR, Law ZK, Bath PM et al (2018) Haemostatic therapies for acute spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev 4(4):D5951
12.
Balachandran VP, Gonen M, Smith JJ et al (2015) Nomograms in oncology: more than meets the eye. Lancet Oncol 16(4):e173–e180CrossRef
13.
Cappellari M, Mangiafico S, Saia V et al (2019) IER-SICH nomogram to predict symptomatic intracerebral hemorrhage after thrombectomy for stroke. Stroke 50(4):909–916CrossRef
14.
Zhang S, Zhang X, Ling Y et al (2019) Predicting recurrent hypertensive intracerebral hemorrhage: derivation and validation of a risk-scoring model based on clinical characteristics. World Neurosurg 127:e162–e171CrossRef
15.
Cappellari M, Turcato G, Forlivesi S et al (2018) STARTING-SICH nomogram to predict symptomatic intracerebral hemorrhage after intravenous thrombolysis for stroke. Stroke 49(2):397–404CrossRef
16.
You S, Zheng D, Delcourt C et al (2019) Determinants of early versus delayed neurological deterioration in intracerebral hemorrhage. Stroke 50(6):1409–1414CrossRef
17.
Sun W, Pan W, Kranz PG et al (2013) Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage. Neurocrit Care 19(3):299–305CrossRef
18.
Lord AS, Gilmore E, Choi HA et al (2015) Time course and predictors of neurological deterioration after intracerebral hemorrhage. Stroke 46(3):647–652CrossRef
19.
Iglesias-Rey R, Rodríguez-Yáñez M, Arias S et al (2018) Inflammation, edema and poor outcome are associated with hyperthermia in hypertensive intracerebral hemorrhages. Eur J Neurol 25(9):1161–1168CrossRef
20.
Andrews P, Verma V, Healy M et al (2018) Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations. Br J Anaesth 121(4):768–775CrossRef
21.
Alrahbi S, Alaraimi R, Alzaabi A et al (2018) Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. CJEM 20(2):256–259CrossRef
22.
Anderson CS, Heeley E, Huang Y et al (2013) Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 368(25):2355–2365CrossRef
23.
Hanley DF, Thompson RE, Rosenblum M et al (2019) Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 393(10175):1021–1032CrossRef
24.
Mendelow AD, Gregson BA, Fernandes HM et al (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365(9457):387–397CrossRef
25.
Zhou X, Chen J, Li Q et al (2012) Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: a meta-analysis of randomized controlled trials. Stroke 43(11):2923–2930CrossRef
26.
Fogelholm R, Murros K, Rissanen A et al (2005) Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study. J Neurol Neurosurg Psychiatry 76(3):349–353CrossRef
27.
Stead LG, Jain A, Bellolio MF et al (2010) Emergency Department hyperglycemia as a predictor of early mortality and worse functional outcome after intracerebral hemorrhage. Neurocrit Care 13(1):67–74CrossRef
28.
Passero S, Ciacci G, Ulivelli M (2003) The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage. Neurology 61(10):1351–1356CrossRef
29.
Sun W, Peacock A, Becker J et al (2012) Correlation of leukocytosis with early neurological deterioration following supratentorial intracerebral hemorrhage. J Clin Neurosci 19(8):1096–1100CrossRef
30.
Kim Y, Han MH, Kim CH et al (2017) Increased short-term mortality in patients with spontaneous intracerebral hemorrhage and its association with admission glucose levels and leukocytosis. World Neurosurg 98:503–511CrossRef
31.
Agnihotri S, Czap A, Staff I et al (2011) Peripheral leukocyte counts and outcomes after intracerebral hemorrhage. J Neuroinflammation 8:160CrossRef
32.
Kim KH (2009) Predictors of 30-day mortality and 90-day functional recovery after primary intracerebral hemorrhage: hospital based multivariate analysis in 585 patients. J Korean Neurosurg Soc 45(6):341–349CrossRef
Metadata
Title
Construction of a nomogram to reveal the prognostic benefit of spontaneous intracranial hemorrhage among Chinese adults: a population-based study
Authors
Gui-Jun Zhang
Jie-Yi Zhao
Tao Zhang
Chao You
Xiao-Yu Wang
Publication date
01-04-2022
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 4/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-021-05684-3

Other articles of this Issue 4/2022

Neurological Sciences 4/2022 Go to the issue

COVID-19

In-hospital and out-of-hospital stroke in patients with COVID-19: two different diseases?

Original Article

Mutational and clinical spectrum of centronuclear myopathy in 9 cases and a literature review of Chinese patients

Letter to the Editor

Brain-computer interface as complementary therapy for hemiparesis in an astrocytoma patient

Review Article

Audio-visual stimulation for visual compensatory functions in stroke survivors with visual field defect: a systematic review

Original Article

Dentate-nucleus gadolinium deposition on magnetic resonance imaging: ultrasonographic and clinical correlates in multiple sclerosis patients

History of Neurology

Mansur ibn Ilyas Shirazi (1380–1422 AD), a pioneer of neuroanatomy