Analysis of Prognostic Factors for Drilling Drainage Surgery in Patients with Hypertensive Intracerebral Hemorrhage and Development of a Predictive Nomogram.

Abstract

Objective: To investigate the influencing factors affecting prognosis in patients undergoing drilling drainage surgery for hypertensive intracerebral hemorrhage (HICH) and to construct a nomogram predictive model.

Methods: Clinical data of 247 patients with HICH admitted to our hospital between October 2020 and February 2024 were retrospectively analyzed. Patients were divided into a modeling cohort (173 cases) and a validation cohort (74 cases). The modeling group was separated into a good prognosis group and a poor prognosis group based on postoperative prognosis.

Results: Among the 173 patients in the modeling cohort, 19 patients (10.98%) experienced poor prognosis. Multivariate logistic regression analysis showed that age, preoperative GCS score, diabetes history, systolic blood pressure, diastolic blood pressure, pulmonary infection and postoperative hematoma volume were the risk factors for the prognosis of drilling drainage surgery for patients with HICH (P<0.05). The AUC of the modeling group and validation group was 0.962 and 0.946, and the H-L test showed χ ²=7.105 and 7.246, with P<0.05 for both, indicating favorable consistency of the model. Decision curve analysis (DCA) showed high clinical utility of the nomogram model within the probability threshold range of 0.05 to 0.93.

Conclusion: Age, preoperative GCS score, history of diabetes, systolic blood pressure, diastolic blood pressure, pulmonary infection and postoperative hematoma volume are key prognostic factors affecting outcomes after drilling drainage surgery in HICH patients. The established nomogram model based on these variables accurately predicts the risk of poor postoperative prognosis and can serve as an effective clinical reference tool.