Construction and verification of a nomogram prediction model for the occurrence of malignant cerebral edema following thrombolytic treatment of acute cerebral infarction

LI Qi-ling; LIU Min; LI Jun; CHEN Hong-tao; GUO Hua-ijie; CHEN Jian-xia

doi:10.13798/j.issn.1009-153X.2024.11.007

Abstract：Objective To explore the risk factors of malignant cerebral edema(MCE)following thrombolytic treatment for acute cerebral infarction(ACI)and to construct a nomogram prediction model.Methods The clinical data of 233 patients with ACI who underwent thrombolytic treatment from October 2019 to September 2022 were retrospectively analyzed.MCE was defined as a decline in the level of consciousness or deterioration of neurological function within 72 hours after thrombolytic treatment,and the area of cerebral infarction exceeding half of the territory supplied by the middle cerebral artery with a midline shift＞5 mm as shown by head MRI or CT.A multivariate logistic regression model was employed to analyze the independent risk factors for MCE.A nomogram prediction model was constructed using the R software package and internally validated by the Bootstrap method.The receiver operating characteristic(ROC)curve was plotted to assess the predictive efficacy of the model.Results Of the 233 patients,50 patients(21.5%)developed MCE.Multivariate logistic regression analysis revealed that age(OR=1.238;95%CI 1.081～1.419;P=0.002),the area of cerebral infarction(OR=1.912;95%CI 1.115～3.280;P=0.019),the time from onset to thrombolysis(OR=9.828;95%CI 1.829～52.815;P=0.008),white blood cell(OR=2.289;95%CI 1.376～3.809;P=0.001),and the NIHSS score before thrombolysis(OR=6.503;95%CI 2.318～18.245;P＜0.001)were independent risk factors for MCE after thrombolytic treatment for ACI.Based on the above findings,a nomogram prediction model was successfully constructed.The Bootstrap method validation indicated that the calibration curve of the model approached the ideal curve(the concordance index was 0.746;P=0.459).The ROC curve analysis demonstrated that the area under the curve for predicting the risk of MCE after thrombolytic treatment for ACI was 0.977(95%CI 0.951～0.999),indicating high predictive efficacy.Conclusions Age,the time from onset to thrombolysis,the area of cerebral infarction,white blood cell,and the NIHSS score before thrombolysis are independent risk factors for MCE after thrombolytic treatment for ACI.The nomogram risk prediction model constructed based on these factors has a high predictive efficacy for MCE after thrombolytic treatment for ACI.