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. 2025 Jan 8;15(1):1300.
doi: 10.1038/s41598-024-80264-x.

Development and validation of a prognostic nomogram for predicting outcomes in brainstem hemorrhage patients

Shuo Wei #  1 , Longyuan Gu #  2 , Yuechao Fan  1 , Peizhi Ji  1 , Liechi Yang  1 , Fengda Li  3 , Shuhong Mei  4
Affiliations

Development and validation of a prognostic nomogram for predicting outcomes in brainstem hemorrhage patients

Shuo Wei et al. Sci Rep. .

Abstract

Brainstem hemorrhage is a severe neurological condition with high mortality and poor prognosis. This study aims to develop and validate a prognostic model for brainstem hemorrhage to facilitate early prediction of patient outcomes, thereby supporting clinical decision-making. Clinical data from 140 patients with brainstem hemorrhage were collected. A prognostic model was constructed through multivariate logistic regression analysis, and a nomogram was developed for clinical use. The model's performance was evaluated using ROC curves, PR curves, and calibration curves, and was validated through cross-validation and an independent validation cohort. Additionally, decision curve analysis was conducted to assess the model's clinical benefit. The study identified hematoma expansion (adjusted OR = 12.92, 95% CI: 2.39-69.79, P = 0.003), GCS score (adjusted OR = 0.77, 95% CI: 0.63-0.93, P = 0.008), hematoma type (OR = 8.01, 95% CI: 2.02-31.78, P = 0.003), and hematoma volume (OR = 1.75, 95% CI: 1.26-2.43, P = 0.001) as independent risk factors for poor prognosis in patients with brainstem hemorrhage. The nomogram prognostic model demonstrated excellent performance in predicting clinical outcomes, with an AUC of 0.95, outperforming individual predictors (volume: 0.94, type: 0.8, GCS: 0.78, expansion: 0.59). Calibration curves showed a high degree of agreement between the model and the ideal curve. Moreover, decision curve analysis indicated that the model provided significant net clinical benefit. This nomogram can effectively provide a basis for prognostic judgment in brainstem hemorrhage, helping clinicians optimize treatment decisions and improve patient outcomes.

Keywords: Brainstem hemorrhage; Clinical decision-making; Nomogram; Prognostic model; Risk factors.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Consent statement: Informed consent has been obtained from all participants and/or their legal guardians for this study. Before the study began, the participants and/or their legal guardians were fully informed of the purpose, procedures, potential risks and benefits of the study and had the opportunity to ask any questions. All participants and/or their legal guardians signed the informed consent form and agreed to voluntarily participate in this study. This statement ensures that the study meets ethical requirements and proves that the participants or their legal guardians have been fully informed and are willing to participate in the study.

Figures

Fig. 1
Fig. 1
Hemorrhage Volume Delineation Diagram.
Fig. 2
Fig. 2
Nomogram for Predicting Prognosis in Brainstem Hemorrhage Patients.
Fig. 3
Fig. 3
ROC Curves for Training and Testing Sets.
Fig. 4
Fig. 4
PR Curves for Training and Testing Sets.
Fig. 5
Fig. 5
Calibration Curves for Training and Testing Sets.
Fig. 6
Fig. 6
Decision Curve Analysis (DCA) for Training and Testing Sets.
See this image and copyright information in PMC

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