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Multicenter Study
. 2022 Jul 26;6(14):4320-4329.
doi: 10.1182/bloodadvances.2022007226.

Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study

Shan Chong  1   2   3   4 , Peng Zhao  1   2   3   4 , Rui-Bin Huang  5 , Hu Zhou  6 , Jia-Ning Zhang  7 , Ming Hou  8 , Yi Liu  9 , Hong-Xia Yao  10 , Ting Niu  11 , Jun Peng  8 , Ming Jiang  12 , Yan-Qiu Han  13 , Jian-Da Hu  14 , Ze-Ping Zhou  15 , Lin Qiu  16 , Lian-Sheng Zhang  17 , Xin Wang  18 , Hua-Quan Wang  19 , Ru Feng  20 , Lin-Hua Yang  21 , Liang-Ming Ma  22 , Shun-Qing Wang  23 , Pei-Yan Kong  24 , Wen-Sheng Wang  25 , Hui-Ping Sun  26 , Jing Sun  27 , He-Bing Zhou  28 , Tie-Nan Zhu  29 , Li-Ru Wang  30 , Jing-Yu Zhang  31 , Qiu-Sha Huang  1   4 , Hai-Xia Fu  1   2   3   4 , Ye-Jun Wu  1   2   3   4 , Yue-Ying Li  32 , Qian-Fei Wang  32 , Qian Jiang  1   2   3   4 , Hao Jiang  1   2   3   4 , Jin Lu  1   2   3   4 , Xiao-Jun Huang  1   2   3   4 , Xiao-Hui Zhang  1   2   3   4
Affiliations
Multicenter Study

Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study

Shan Chong et al. Blood Adv. .

Abstract

Intracranial hemorrhage (ICH) is a rare and life-threatening hemorrhagic event in patients with immune thrombocytopenia (ITP). However, its mortality and related risk factors remain unclear. Herein, we conducted a nationwide multicenter real-world study of ICH in adult ITP patients. According to data from 27 centers in China from 2005 to 2020, the mortality rate from ICH was 33.80% (48/142) in ITP adults. We identified risk factors by logistic univariate and multivariate logistic regression for 30-day mortality in a training cohort of 107 patients as follows: intraparenchymal hemorrhage (IPH), platelet count ≤10 × 109/L at ICH, a combination of serious infections, grade of preceding bleeding events, and Glasgow coma scale (GCS) level on admission. Accordingly, a prognostic model of 30-day mortality was developed based on the regression equation. Then, we evaluated the performance of the prognostic model through a bootstrap procedure for internal validation. Furthermore, an external validation with data from a test cohort with 35 patients from 11 other centers was conducted. The areas under the receiver operating characteristic (ROC) curves for the internal and external validation were 0.954 (95% confidence interval [CI], 0.910-0.998) and 0.942 (95% CI, 0.871-1.014), respectively. Both calibration plots illustrated a high degree of consistency in the estimated and observed risk. In addition, the decision curve analysis showed a considerable net benefit for patients. Thus, an application (47.94.162.105:8080/ich/) was established for users to predict 30-day mortality when ICH occurred in adult patients with ITP.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
ROC curve of the prognostic model in the training and test cohorts. (A) ROC curve of the prognostic model for the training. The area under the curve (AUC) was 0.954 (95% CI, 0.910-0.998). (B) ROC curve of the prognostic model for the test cohort. The AUC was 0.942 (95% CI, 0.871-1.014).
Figure 2.
Figure 2.
Calibration plot of the prognostic model in the training and test cohorts. (A) Calibration plot of the prognostic model for the training cohort. (B) Calibration plot of the prognostic model system for the test cohort. The x-axis plots the predicted 30-day mortality of ICH in adult patients with ITP; the y-axis plots the observed 30-day mortality in our study. A 45° diagonal line represents the ideal calibration plot.
Figure 3.
Figure 3.
Decision curve analysis of the prognostic model in the training and test cohorts. (A) Decision curve analysis of the prognostic model for the training cohort. (B) Decision curve analysis of the prognostic model for the test cohort. Black line: assuming no patient died within 30 days. Gray line: assuming all patients died within 30 days. These 2 lines served as references.
Figure 4.
Figure 4.
An application (47.94.162.105:8080/ich/) to predict the 30-day mortality of intracranial hemorrhage (ICH) in ITP patients. Users can visit the site and fill in these associated clinical features. After submission, the application can automatically output the patient's risk of death within 30 days following ICH in the form of a percentage.
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References

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