重型幕上高血压性脑出血患者术后慢性意识障碍预测模型的构建与验证OA

Objective To explore influencing factors of postoperative prolonged disorders of consciousness(pDoC)in patients with severe supratentorial hypertensive intracerebral hemorrhage(HICH),and to construct a prediction model.Methods Clinical data of 222 patients with severe supratentorial HICH admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Fuyang Normal University from January 2017 to June 2024 were retrospectively analyzed.The patients were randomly divided into a training set(155 cases)and a validation set(67 cases)according to the ratio of 7 to 3.pDoC was defined as postoperative unconsciousness lasting≥28 days.Patients in the training set were grouped into two groups according to the occurrence of pDoC,namely pDoC group(55 cases)and non-pDoC group(100 cases).The influencing factors of pDoC were selected by multivariable Logistic regression analysis.The R software was used to establish a nomogram prediction model based on the above influencing factors.The receiver operating characteristic(ROC)curve and calibration curve were plotted in both the training and validation sets,and decision curve analysis(DCA)and the Hosmer-Lemeshow goodness-of-fit test were performed.Results Significant differences were observed between the pDoC and non-pDoC groups in terms of gender(χ2=4.448),pre-admission vomiting(χ2=4.111),preoperative Glasgow Coma Scale(GCS)score(Z=-7.462),systolic blood pressure(Z=-3.798),hematoma volume(Z=-4.199),modified Graeb Scale(mGS)score(Z=-4.496),cerebral hernia(χ2=44.780),decompressive craniectomy(χ2=45.160),surgical approach(χ2=13.569),concomitant stress ulcer(χ2=8.093),white blood cell count(Z=-3.564),serum potassium level(Z=-2.609),and blood glucose level(Z=-4.424),all with P<0.05.Multivariate Logistic regression analysis showed that preoperative GCS score,systolic blood pressure,hematoma volume,and mGS score were influencing factors for postoperative pDoC in severe supratentorial HICH patients(OR=0.416,1.021,1.041,1.188,respectively;all P<0.05).The ROC curve of the prediction model showed an area under the curve(AUC)of 0.905(95%CI=0.853-0.957)in the training set and 0.857(95%CI=0.765-0.949)in the validation set.Calibration curves in both the training and validation sets showed good agreement between predicted probability and actual probability.DCA indicated that the nomogram prediction model demonstrated a favorable net benefit in clinical decision-making.The Hosmer-Lemeshow goodness-of-fit test demonstrated good fit in both the training and the validation sets(χ2=5.435,3.586,respectively;P>0.05).Conclusion Preoperative GCS score,systolic blood pressure,hematoma volume,and mGS score are influencing factors for postoperative pDoC in severe supratentorial HICH patients.The nomogram prediction model based on these factors shows good discrimination,goodness-of-fit,and clinical applicability,and can provide a reference for clinical decision-making.