Prediction nomogram for postoperative infection in patients with hypertensive intracerebral hemorrhage

Hu Pei; Wang Yuan; Wang Mengyang; Huang Conggang; Li Qianfeng; Luo Zhihua; Chen Lyuqi; Duan Faliang

doi:10.11986/j.issn.1673-873X.2025.11.03

Abstract：Objective To develop a nomogram predicting postoperative infection in patients with hypertensive intracerebral hemorrhage(HICH),with the aim of facilitating early identification and targeted intervention for high-risk patients.Methods We retrospectively enrolled 275 HICH patients treated at Wuhan No.1 Hospital from July 2020 to April 2024.Patients were assigned to an infection group(n=47)and a non-infection group(n=228)according to whether postoperative infection occurred.Multivariable logistic regression a-nalysis was used to identify independent risk factors for postoperative infection;a nomogram was then constructed based on these fac-tors.The nomogram's discriminative performance was assessed by the receiver operating characteristic(ROC)curve and its calibration was evaluated with a calibration curve.Results There were no significant differences between the infection and non-infection groups in sex composition,body mass index,comorbid baseline diseases,hemorrhage location,National Institutes of Health Stroke Scale(NIH-SS)score on admission,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score on admission,time from onset to sur-gery,surgical approach,intraoperative blood loss,operation time,type of nutritional support,smoking history,alcohol history,history of anticoagulant or antiplatelet use,intraoperative blood transfusion,prophylactic proton pump inhibitor(PPI)use,nasogastric tube placement,or admission values of White blood cell count(WBC),lactate(Lac),procalcitonin(PCT),albumin(ALB)and platelet-to-lymphocyte ratio(PLR;P＞0.05).Compared with the non-infection group,the infection group had higher age,greater proportion with hypertension duration ≥10 years,higher rate of intraventricular extension,higher proportion with hematoma volume ≥30 mL on admission,higher proportion with Glasgow Coma Scale(GCS)≤8 on admission,higher rates of invasive assisted ventilation and me-chanical ventilation ≥3 days,and higher fasting blood glucose(FBG)on admission and neutrophil-to-lymphocyte ratio(NLR;P＜0.05).Multivariable logistic regression analysis identified hypertension duration ≥10 years(OR=2.790,95％CI:1.227-6.342),intraventricular extension(OR=4.187,95％CI:1.529-11.467),and GCS ≤8 on admission(OR=2.547,95％CI:1.147-5.656)as independent risk factors for postoperative infection in HICH patients(P＜0.05).ROC curve analysis demonstrated that the nomo-gram predicting postoperative infection achieved an area under the curve(AUC)of 0.909(95％CI:0.855-0.963),with a sensitivity of 86.17％and specificity of 83.33％.The Hosmer-Lemeshow goodness-of-fit test indicated good model fit(x2=5.873,P=0.511).Conclusion Hypertension duration ≥10 years,intraventricular extension,and lower GCS score on admission are independent risk fac-tors for postoperative infection in HICH patients.The nomogram based on these factors demonstrates high predictive performance and may help clinicians identify high-risk patients early and implement targeted interventions to improve outcomes.