Construction of a nomogram prediction model for sICH after intravenous thrombolysis based on systemic inflammatory indicators
10.3969/j.issn.1009-0126.2025.05.020
- VernacularTitle:基于系统性炎性指标构建静脉溶栓后症状性颅内出血的列线图预测模型
- Author:
Xinxin CHEN
1
;
Yan FU
Author Information
1. 100084 北京,清华大学医院神经内科
- Publication Type:Journal Article
- Keywords:
brain infarction;
intracranial hemorrhages;
C-reactive protein;
nomograms
- From:
Chinese Journal of Geriatric Heart Brain and Vessel Diseases
2025;27(5):637-641
- CountryChina
- Language:Chinese
-
Abstract:
Objective To construct a nomogram prediction model for symptomatic intracerebral hemorrhage(sICH)in elderly patients with cerebral infarction after intravenous thrombolysis based on systemic inflammatory indicators.Methods A retrospective study was conducted on 355 elderly patients with cerebral infarction who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in Tsinghua University Hospital from January 2019 to June 2024.They were randomly assigned into a modeling group(249 cases)and a validation group(106 cases)in a 7∶3 ratio.The modeling group was further divided into an sICH subgroup(24 cases)and a non-sICH subgroup(225 cases)based on sICH occurrence after intravenous thrombolysis.The general information and levels of systemic inflammatory indicators were compared between the sICH subgroup and the non-sICH subgroup.Logistic regression was used to identify the influ-encing factors for sICH,and then a nomogram prediction model was constructed.The predictive performance of the model was evaluated through ROC curve and calibration curve analyses,and then the data of the validation group were used for validation.Results The sICH subgroup had significantly larger proportions of atrial fibrillation(AF)and leukoaraiosis at admission,higher baseline NIHSS score,increased neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ra-tio(PLR),and C-reactive protein(CRP)level,but lower lymphocyte to monocyte ratio(LMR)when compared with the non-sICH subgroup(P＜0.05,P＜0.01).ROC curve analysis showed that the AUC value of NIHSS score,NLR,LMR,PLR,and CRP in predicting sICH occurrence in stroke patients after intravenous thrombolysis was 0.796,0.638,0.695,0.725,and 0.686,respec-tively(P＜0.05,P＜0.01).Logistic regression analysis indicated that systemic inflammatory indi-cators NLR,LMR,PLR,CRP level,AF,baseline NIHSS score,and leukoaraiosis at admission were all influencing factors for the occurrence of sICH in these patients(P＜0.05,P＜0.01).The consistency index of the nomogram prediction model based on systemic inflammatory indicators and other factors in predicting the occurrence of sICH was 0.951(95％CI:0.918-0.985),and the calibration curve tended to the ideal curve.The AUC value of the model for the occurrence of sICH in the validation group was 0.980(95％CI:0.956-1.000).Conclusion Our nomogram pre-diction model based on systemic inflammatory indicators NLR,LMR,PLR,CRP,and other major variables has good predictive performance for the occurrence of sICH in elderly patients with cere-bral infarction after rt-PA intravenous thrombolysis.
