A prognostic nomogram incorporating red cell distribution width for patients with intracerebral hemorrhage

Abstract

Intracerebral hemorrhage (ICH) is the second most common subtype of stroke with higher mortality and morbidity, and it lacks effective prognostic markers. The aim of this research is to construct newly valuable prognostic nomogram incorporating red blood cell distribution width (RDW) for ICH patients. We retrospectively analyzed 953 adult patients with ICH. The impacts of RDW on short-term mortality and functional prognosis were calculated using Akaike information criterion (AIC), Bayesian information criteria (BIC) and the area under the curve (AUC) respectively, which could be used to compare with Glasgow coma scale (GCS) and ICH score. The independent factors of prognosis were identified by univariate and multivariate logistic regression analysis. A nomogram based on RDW for nerve functional prognosis was further constructed and validated. Its clinical value was subsequently explored utilizing decision curve analysis. Cumulative clinical results were retrieved for 235 inpatients from Jan 2012 to June 2017. In 30-day mortality sets, GCS and ICH score had better prognostic performance than RDW (AUC: 0.929 and 0.917 vs 0.764; AIC: 124.101 and 134.188 vs 221.372; BIC: 131.021 and 141.107 vs 228.291). In 30-day functional prognosis sets, the consequences of evaluation systems were inconsistent. GCS was the best parameter for predicting outcome using AIC (262.350 vs 276.392 and 264.756) and BIC (269.269 vs 283.311 and 271.675). However, RDW was higher than GCS and ICH score considering AUC (0.784 vs 0.759 and 0.722). Age, GCS, RDW, platelet distribution width, and surgery were independent prognostic factors by multivariate logistic regression analysis, and those coefficients were used to formulate a nomogram. This nomogram can provide accurate prediction with the concordance index of 0.880 (95% CI, 0.837–0.922) higher than Harrell's concordance index of GCS system 0.759 (95% CI, 0.698–0.819) and RDW 0.784 (95% CI, 0.721–0.847). The calibration plots showed optimal consistency between bootstrap-predicted and the actual observed values of 30-day unfavorable prognosis. Decision curve analysis showed an increased net benefit for utilizing the nomogram. High RDW values are associated with an unfavorable outcome after ICH. The established nomogram incorporating RDW should be considered for a 30-day functional prognosis.

Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage

“…The GCS score is the most widely used indicator for assessing the degree of coma in patients, and lower GCS scores are associated with a higher risk of death ( Saika et al, 2015 ; Widyadharma et al, 2021 ). Consistent with our results, many nomogram-based studies have reported that a decrease in GCS scores significantly contributes to an increase in mortality and the likelihood of hematoma expansion in ICH patients ( Yao et al, 2015 ; Cui et al, 2020 ; Chen et al, 2021 ; Kang et al, 2021 ). The bleeding volume increases upon rupture of vessels and can continue to increase after ICH is diagnosed by imaging, and, consequently, the baseline bleeding volume and hematoma enlargement are strongly associated with poor clinical outcomes ( Al-Shahi Salman et al, 2018 ).…”

“…Similar to many previous studies, we found that age ( Inoue et al, 2018 ; He et al, 2020 ), GCS score ( Cui et al, 2020 ), and bleeding volume ( Al-Shahi Salman et al, 2018 ; Du et al, 2020 ; He et al, 2020 ; Kang et al, 2021 ; Masotti et al, 2021 ; Pasi et al, 2021 ) were independent risk factors for the poor prognosis of ICH patients. It is generally believed that the main causes of ICH are hypertension and CAA ( Schrag and Kirshner, 2020 ).…”

Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study

“…In regard to Hb levels, lower mean admission values were recorded in the unfavorable outcome group, without statistical significance or without meeting the criteria of the definition of anemia ( 39 ). RDW is another inexpensive automatically generated hematology parameter that is impacted by inflammation ( 29 ), and our results indicated a modest correlation with admission PHE, but this was not associated with day 90 FO.…”

“…ICH induces a state of systemic and peripheral inflammation, thus increasing circulating WBC and recruiting certain molecules within the affected area, which amplifies local damage (13,22). Previous studies have reported results for several inflammatory biomarkers and calculated indexes (Hb, absolute RDW, GRA, LYM, PLT, NLR, PLR) that contribute to the existing data on FO prognostication (5,6,17,19,28,29,46,47), but the cohort assessed in the present study did not display statistically significant results, only in-line tendencies with previously published evidence. Furthermore, moderate negative correlations were determined between WBC, GRA, SII and PHE growth.…”

“…Regarding Hb, anemia is associated with larger ICH volumes (25), increased HG (26) and worse outcomes (26)(27)(28). RDW is another inexpensive, automatically generated hematology parameter that is impacted by inflammation and is currently associated with day 30 FO (29).…”