ANAID-ICH nomogram for predicting unfavorable outcome after intracerebral hemorrhage

Abstract

Objective: Diffusion-weighted imaging lesions (DWILs) are associated with unfavorable outcome in intracerebral hemorrhage (ICH). We proposed a novel predictive nomogram incorporating DWILs.

Methods: A total of 738 patients with primary ICH in a tertiary hospital were prospectively enrolled as a training cohort. DWILs were defined as remote focal hyperintensities on DWI corresponding to low intensities on apparent diffusion coefficient images and remote from the focal hematoma. The outcome of interest was modified Rankin Scale scores of 4-6 at 90 days after onset. Multivariate logistic regression was used to construct a nomogram. Model performance was tested in the training cohort and externally validated with respect to discrimination, calibration, and clinical usefulness in another institute. Additionally, the nomogram was compared with the ICH score in terms of predictive ability.

Results: Overall, 153 (20.73%) and 23 (15.54%) patients developed an unfavorable outcome in the training and validation cohorts, respectively. The multivariate analysis revealed that age, National Institutes of Health Stroke Scale (NIHSS) score, anemia, infratentorial location, presence of DWILs, and prior ICH were associated with unfavorable outcome. Our ANAID-ICH nomogram was constructed according to the aforementioned variables; the area under the receiver operating characteristic curve was 0.842 and 0.831 in the training and validation sets, respectively. With regard to the 90-day outcome, the nomogram showed a significantly higher predictive value than the ICH score in both cohorts.

Conclusions: The ANAID-ICH nomogram comprising age, NIHSS score, anemia, infratentorial location, presence of DWILs, and prior ICH may facilitate the identification of patients at higher risk for an unfavorable outcome.

Keywords: cerebral hemorrhage; magnetic resonance imaging; nomogram; prognosis.

FIGURE 1

Selection flowchart of included and excluded patients.

FIGURE 2

Representative MRI of diffusion‐weighted imaging lesions (DWILs) in patients with acute intracerebral hemorrhage. In a patient with lobar hemorrhage (A), the lesion (white arrow) appears as hyperintensity on diffusion‐weighted imaging (B) with corresponding hypointensity signal (red arrow) on apparent diffusion coefficient map (C).

FIGURE 3

ANAID‐ICH nomogram for predicting the probability of unfavorable outcome at 90 days after ICH. NIHSS indicates the National Institutes of Health Stroke Scale; DWILs, difussion‐weighted imaging lesions; ICH, intracerebral hemorrhage

FIGURE 4

Receiver operating characteristic curves detect the discriminative ability of nomogram in the training (A) and validation cohort (B). Calibration plot for nomogram‐predicted probability of 90‐day unfavorable outcome in the training (C) and validation cohort (D).

FIGURE 5

Decision curve analysis of our nomogram and ICH score in the training (A) and validation cohorts (B).