International Journal of General Medicine (Sep 2021)
Nomogram Prediction of Short-Term Outcome After Intracerebral Hemorrhage
Abstract
Huili Kang,1,* Qiuqiong Cai,1,* Liang Gong,2 Ying Wang1 1Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People’s Republic of China; 2Department of Neurosurgery, Shanghai Punan Hospital of Pudong New District, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ying WangDepartment of Ultrasound, Shanghai Punan Hospital of Pudong New District, No. 519, South Pier Road, Pudong New District, Shanghai, 200125, People’s Republic of ChinaTel +86-13918901577Email [email protected]: The early symptoms of patients with elevated intracranial pressure (ICP) after intracerebral hemorrhage (ICH) are easily overlooked, which will result in missing the optimal opportunity for clinical intervention. However, it is difficult for ICH patients admitted to the neurology department to receive invasive ICP monitoring, although it is crucial for the early identification of neurologic deterioration (ND).Objective: The aim of this study is to investigate the association between the changes of transcranial Doppler (TCD) variables and ND after onset and establish a nomogram for predicting the short-term outcome of ICH.Methods: A total of 297 patients were recruited and their clinical characteristics and the changes of TCD variables were recorded. The independent prognostic factors for the ND after onset in the ICH patients were screened from multivariate Logistic regression analysis, which were served as inputs for the nomogram construction. Discrimination and calibration validations were performed to assess the performance of the nomogram [concordance index (C-index) for discrimination and Hosmer–Lemeshow (HL) test for calibration] and the decision curve analysis was applied to assess the clinical suitability.Results: ΔaPI [defined as the change of pulsatility index (PI) between the 1st and 3rd day after onset for affected hemisphere] was independently associated with the ND after onset. Moreover, hematoma volume, presence of intraventricular hemorrhage, and Glasgow coma scale were also the independent prognostic factors of ND. The developed nomogram incorporating ΔaPI showed good discrimination (C-index: 0.916 after 1000 bootstrapping) and calibration (P=0.412, HL test) and yielded net benefits.Conclusion: The nomogram incorporating ΔaPI might be useful in predicting the risk of ND within 14 days after onset, which might help identify patients in the neurology department in need of further care.Keywords: nomogram, intracerebral hemorrhage, transcranial Doppler, intracranial pressure, neurologic deterioration, pulsatility index
