高血压脑出血合并急性意识障碍患者遗留慢性意识障碍的影响因素分析及列线图模型构建

Analysis of influencing factors and nomogram model construction for prolonged disorders of consciousness in patients with hypertensive intracerebral hemorrhage complicated by acute disorders of consciousness

摘要:

目的 探讨高血压脑出血合并急性意识障碍患者遗留慢性意识障碍的影响因素并构建预测模型。方法 回顾性分析2021年6月至2023年6月南京医科大学第一附属医院神经外科收治高血压脑出血合并急性意识障碍患者172例的临床资料，所有患者出院后随访时间≥3个月，根据发病3个月时修订版昏迷恢复量表（CRS-R）评分分为遗留意识障碍组（n=46）和未遗留意识障碍组（n=126)。结果 两组在年龄、糖尿病史、入院时格拉斯哥昏迷评分（GCS）等比较，差异有统计学意义（P＜0.05）。二元Logistic回归分析显示：发病7 d时，高GCS（OR=1.387，95%CI=1.129～1.702）为遗留慢性意识障碍的保护因素，而糖尿病史（OR=0.274，95%CI=0.093～0.806)、丘脑出血（OR=0.033，95%CI=0.003～0.366）和继发脑梗死（OR=0.283，95%CI=0.106～0.755）为危险因素。基于上述因素构建的列线图预测模型显示一致性指数为0.822，校准曲线接近标准曲线，平均绝对误差为0.037，预测效能良好。结论 发病7 d时GCS、糖尿病史、丘脑出血和继发脑梗死是影响脑出血合并急性意识障碍患者遗留慢性意识障碍的重要因素，基于这些因素构建的预测模型具有较高准确度。

Abstract:

Objective To investigate the influencing factors associated with progression to prolonged disorders of consciousness in patients with hypertensive intracerebral hemorrhage complicated by acute consciousness impairment and to develop a predictive model.Methods This study was based on a retrospective analysis of 172 patients admitted to the Department of Neurosurgery at The First Affiliated Hospital of Nanjing Medical University from June 2021 to June 2023. All patients presented with acute disorders of consciousness， defined by Glasgow coma scale （GCS） of 3-12 upon admission. The study population was divided into prolonged disorders of consciousness （n=46） and non-prolonged disorders of consciousness （n=126） groups based on Coma Recovery Scale-Revised （CRS-R） assessments conducted during a minimum three-month follow-up period.Results Statistical analysis revealed significant differences between the groups across multiple variables， including age， diabetes history， admission GCS， hemorrhage location， hematoma volume， preoperative midline shift， GCS scores at seven days post-onset， and the occurrence of secondary cerebral infarction （P<0.05）. Binary logistic regression analysis identified several independent factors affecting consciousness outcomes. A higher GCS at seven days post-onset emerged as a protective factor （OR=1.387， 95% CI=1.129～1.702）， while a history of diabetes （OR=0.274， 95% CI=0.093～0.806）， thalamic hemorrhage （OR=0.033， 95% CI=0.003～0.366）， and secondary cerebral infarction （OR=0.283， 95% CI=0.106～0.755，） were identified as independent risk factors for prolonged disorders of consciousness. Based on these findings， a nomogram prediction model was developed， demonstrating excellent predictive capability with a concordance index of 0.822 and robust calibration （average absolute error=0.037）.Conclusions Study findings indicate that the GCS at 7 days post-onset， history of diabetes mellitus， thalamic hemorrhage， and secondary cerebral infarction constitute critical determinants influencing progression to prolonged disorders of consciousness in patients with intracerebral hemorrhage complicated by acute consciousness impairment. The predictive model incorporating these factors demonstrated high accuracy.