A 6-month prognostic nomogram incorporating hemoglobin level for intracerebral hemorrhage in young adults

Objective: — Intracerebral hemorrhage (ICH) is the second most common subtype of stroke with higher mortality and morbidity, and it lacks effective 6-month prognostic markers,especially in young patients.The aim of this research is to construct a newly valuable prognostic nomogram model incorporating hemoglobin level for young patients with ICH. Method: — Patients aged between 18 and 50 years with first-ever intracerebral hemorrhageselected from Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January1,2012 to December 31,2018.We retrospectively analyzed 565 young patients with ICH. The independent factors of prognosis were identified by univariate and multivariate logistic regression analysis. Then，based on independent risk factors,a new nomogram model was further constructed and validated. Its clinical value was subsequently explored utilizing decision curve analysis and clinical impact curve. Results: — A total of 565 patients were enrolled in this study.There were 117 patients (20.7%) who developed unfavourable prognosis. Infratentorial lesion(adjusted odds ratio [aOR]=3.708,95%confidence interval [CI],1.490-9.227; P=0.005)was most significant with unfavourable outcome.Age([aOR]=1.054;95%CI,1.014-1.096;P=0.008),hematoma volume(aOR=1.014,95%CI,1.002-1.027;P=0.024),hemoglobin(aOR=0.981,95% CI,0.969-0.993;P=0.002),blood glucose(aOR=1.135,95%CI,1.037-1.241; P=0.005)and NIHSS(aOR=1.105,95%CI,1.069-1.141;P<0.001) were independent rish factors.Based on these 6 factors,a reliable nomogram was constructed for the prediction of unfavourable prognosis in our study(C-index=0.791). Decision curve analysis and clincal impact curve showed showed an increased net benefit for utilizing the nomogram. Conclusion: — The hemoglobin level at admission may be an easily overlooked factor in clinical work.This new nnomogram model could be a promising and convient tool to predict the early functional prognosis of in young people with ICH.In addition, more prospective multicenter studies are needed to cestimate these findings.