Objective: To investigate the value of a nomogram predicting the outcome of intracerebral hemorrhage (ICH) based on clinical characteristics and diffusion-weighted imaging (DWI) of hyperintense lesions. Methods: A case-control study. Consecutive patients, aged 30-88(59±13) years old, with ICH were recruited at the Stroke Center of Zhengzhou People's Hospital from January 2018 to August 2021. Patients were divided into a group with DWI lesions and a group without DWI lesions depending on whether there were DWI hyperintense lesions distant from the hematoma. Prognosis was evaluated at 90 days via the modified Rankin Scale (mRS). Univariate and multivariable logistic regression models were used to identify independent predictors of a poor ICH outcome (mRS score≥4), and a nomogram model was developed. The performance of the nomogram was validated via the area under the receiver operating characteristic curve (AUC) and a calibration chart. Results: Of the 303 patients included in the study, 24.8% presented with DWI lesions; 17.5% with asymptomatic DWI lesions and 7.3% with symptomatic DWI lesions. Poor outcomes were significantly more frequent in the group with DWI lesions than in the group without DWI lesions (χ2=21.32, P<0.001). In multivariable regression analysis, age [odds ratio (OR)=1.032, 95% confidence interval (CI) 1.002-1.063, P=0.035], hematoma volume (OR=1.050, 95%CI 1.011-1.090, P=0.012), hematoma location (OR=3.839, 95%CI 1.248-11.805, P=0.019), DWI lesions (OR=3.955, 95%CI 1.906-8.206, P<0.001), and baseline NIHSS scores (OR=1.102, 95%CI 1.038-1.170, P=0.001) were independent predictors of a poor outcome. In subgroup analysis patients with asymptomatic DWI lesions had a 3-fold greater risk of a poor outcome compared to those without DWI lesions (OR=3.135, 95%CI 1.382-7.112, P=0.006), and patients with symptomatic DWI lesions had a 7-fold greater risk of a poor outcome compared to those without DWI lesions (OR=7.126, 95%CI 2.279-22.277, P=0.001). A nomogram model was established based on the independent predictors for a poor outcome. The AUC of the nomogram was 0.846 (95%CI 0.795-0.898), and a calibration chart indicated good consistency between values predicted by the nomogram and actual observed values. Conclusions: DWI lesions are an independent risk factor for a poor outcome in patients with ICH-particularly symptomatic DWI lesions. A nomogram model based on clinical characteristics and DWI lesions exhibited good efficacy when predicting the outcome of ICH.
目的： 探讨基于临床和磁共振扩散加权成像（DWI）高信号病变的列线图对脑出血（ICH）患者预后的预测价值。 方法： 病例对照研究。连续收集2018年1月至2021年8月郑州人民医院卒中中心收治的ICH患者，年龄30~88（59±13）岁，依据远离血肿部位是否存在DWI高信号病变分为DWI病变组和无DWI病变组，改良Rankin量表（mRS）评估90 d预后。采用单因素及多因素logistic回归分析筛查ICH不良预后（mRS≥4分）的独立危险因素，并构建列线图，通过受试者工作特征曲线下面积（AUC）和校准图验证列线图模型的性能。 结果： 303例ICH患者中有24.8%伴发DWI病变，17.5%为无症状性，7.3%为症状性。DWI病变组不良预后率显著高于无DWI病变组，差异有统计学意义（χ2=21.32，P<0.001）；多因素logistic回归分析显示，年龄（OR=1.032，95%CI 1.002~1.063，P=0.035）、血肿体积（OR=1.050，95%CI 1.011~1.090，P=0.012）、血肿部位（OR=3.839，95%CI 1.248~11.805，P=0.019）、DWI病变（OR=3.955，95%CI 1.906~8.206，P<0.001）、基线NIHSS评分（OR=1.102，95%CI 1.038~1.170，P=0.001）是ICH患者不良预后的独立危险因素。亚组分析显示，伴发无症状性DWI病变组不良预后是无DWI病变组的3倍（OR=3.135，95%CI 1.382~7.112，P=0.006），而伴发症状性DWI病变组不良预后是无DWI病变组的7倍（OR=7.126，95%CI 2.279~22.277，P=0.001）。依据独立危险因素构建列线图预测模型，ACU为0.846（95%CI 0.795~0.898），校准图的预测值与实测值一致性良好。 结论： DWI病变是ICH不良预后的独立危险因素，尤其是伴发症状性DWI病变，基于临床和DWI病变构建的列线图对ICH预后具有良好的预测效能。.