Construction of a nomogram model for risk prediction of rebleeding in patients with spontaneous intracerebral hemorrhage in ICU
Objective To investigate the influencing factors of rebleeding in patients with spontaneous intracerebral hemorrhage in intensive care unit(ICU),and to establish a nomogram prediction model.Methods The clinical data of 173 patients with spontaneous cerebral hemorrhage in ICU of Wuxi Second People's Hospital from June 2019 to June 2022 were retrospectively analyzed.According to whether the patients had rebleeding or not,they were divided into a rebleeding group(38 cases)and a non-rebleeding group(135 cases).The general data of the two groups were compared.Multivariate logistic regression analysis was used to analyze the influencing factors of rebleeding in patients with spontaneous intracerebral hemorrhage in ICU.R3.4.3 software package was used to draw the nomogram model,and the receiver operating characteristic curve(ROC)was drawn to evaluate the predictive efficacy of the nomogram model.The calibration curve was drawn to evaluate the discrimination of the nomogram model,and the Bootstrap method was used to test the consistency of the prediction nomogram model,t test and x2 test were used.Results In the rebleeding group,there were 24 males and 14 females,aged(61.57±7.5 3)years.In the non-rebleeding group,there were 75 males and 60 females,aged(59.08± 7.39)years.There were no statistically significant differences in the gender,age,body mass index(BMI),smoking history,drinking history,diabetes history,etiology classification,Glasgow Coma Scale(GCS)score,hematoma shape,hematoma location,bleeding volume,operation mode,preoperative systolic blood pressure,preoperative diastolic blood pressure,preoperative platelet count,and postoperative use of hemostatic drugs between the rebleeding group and the non-rebleeding group(all P＞0.05).In the rebleeding group,the ratios of long-term use of anticoagulants,uneven hematoma density,operation timing of 3-6 h,unsatisfactory postoperative blood pressure control,and postoperative agitation and levels of preoperative blood glucose and preoperative D-dimer were higher than those in the non-rebleeding group[47.37％(18/38)vs.24.44％(33/135),71.05％(27/38)vs.43.70％(59/135),31.58％(12/38)vs.10.37％(14/135),18.42％(7/38)vs.2.96％(4/135),42.11％(16/38)vs.22.96％(31/135),(6.39±1.02)mmol/L vs.(5.95±1.25)mmol/L,(0.51±0.04)mg/L vs.(0.43±0.05)mg/L],with statistically significant differences(x2=7.496,8.872,10.476,12.924,and 5.491,t=1.990 and 9.073;all P＜0.05).Multivariate logistic regression analysis showed that long-term use of anticoagulants,uneven hematoma density,operation timing of 3-6 h,elevated preoperative D-dimer level,unsatisfactory postoperative blood pressure control,and postoperative agitation were all risk factors for rebleeding in ICU patients with spontaneous cerebral hemorrhage(all P＜0.05).ROC analysis results showed that the area under the curve(AUC),sensitivity,and specificity of the nomogram for predicting rebleeding in ICU patients with spontaneous cerebral hemorrhage were 0.848(95％CI 0.799-0.887),76.32％,and 84.44％,respectively.The Bootstrap method was used to verify the model,and the consistency index(C-index)was 0.829.The calibration curve was in good agreement with the standard curve.Conclusions Long-term use of anticoagulants,uneven hematoma density,operation timing of 3-6 h,elevated D-dimer level,unsatisfactory postoperative blood pressure control,and postoperative agitation are all risk factors for rebleeding in patients with spontaneous cerebral hemorrhage in ICU.The nomogram model based on the above influencing factors has good predictive efficacy,which is conducive to early clinical screening of rebleeding in ICU patients with spontaneous cerebral hemorrhage.
万方数据
维普
