Risk factors for cerebral edema secondary to cerebral hemorrhage and the construction of a nomogram model

CHEN Yunyun; Zhou Yi; WU Tingting; QIN Dan; XUE Liuyuan

doi:10.3639/j.issn.1671-2897.2025.03.011

Abstract：Objective To analyze the risk factors for secondary cerebral edema in patients with cerebral hemorrhage and to construct its nomogram model.Methods The clinical data of 210 patients with cerebral hemorrhage admitted to Rugao People's Hospital from July 2022 to June 2024 were retrospectively analyzed.The patients were divided into cerebral edema group(n=89)and non-cerebral edema group(n=121)according to the secondary cerebral edema data.The influencing factors for secondary cerebral edema in patients with cerebral hemorrhage were explored by Multivariate Logistic regression analysis,and a nomogram model was constructed.The value of the nomogram model in predicting secondary cerebral edema in patients with cerebral hemorrhage was evaluated by ROC.Results The age≥60 years and the Glasgow Coma Scale(GCS)score<9 on admission in cerebral edema group were higher than those in non-cerebral edema group,the time from onset to admission was longer than that in non-cerebral edema group,the amount of hematoma was greater than that in non-cerebral edema group,and the leukocyte count,neutrophil,neutrophil/lymphocyte ratio(NLR)and fibrinogen level were higher than those in non-cerebral edema group.The lymphocyte level was lower than that in non-cerebral edema group(P<0.05).Multivariate analysis showed that age≥60 years old(OR=1.891,95%CI:1.374-2.603),low GCS score at admission(OR=0.433,95%CI:0.298-0.631),large hematoma(OR=2.158,95%CI:1.493-3.119),high NLR(OR=2.575,95%CI:1.686-3.933)and elevated fibrinogen level(OR=2.737,95%CI:1.775-4.221)were independent risk factors for secondary cerebral edema in patients with cerebral hemorrhage(P<0.05).A nomogram model was constructed to predict secondary cerebral edema in patients with cerebral hemorrhage.The results showed that the consistency index(C-index)was 0.869(95%CI:0.816-0.922).The area under the curve(AUC)(95%CI)for predicting secondary cerebral edema in patients with cerebral hemorrhage was 0.873(0.820-0.926),the specificity was 67.92%and the sensitivity was 91.85%.Conclusions The risk factors for secondary cerebral edema in patients with cerebral hemorrhage include age,GCS score at admission,hematoma volume,NLR and fibrinogen.The nomogram model based on this analysis has certain predictive value for secondary cerebral edema in patients with cerebral hemorrhage.