Abstract

Background and Purpose Spontaneous intracerebral hemorrhage (sICH) patients were susceptible to pulmonary embolism (PE), which is frequently neglected due to the absence of predictive tools for early detection. This study aimed to investigate the risk factors of PE in sICH patients and develop a efficient model for the prediction of PE in clinical practice.

Materials and methods We conducted a retrospective study involving 1129 sICH patients. The enrolled patients were divided into training set, internal validation set and external set (n=525: 357: 247). The univariate and multivariate stepwise logistic regression analyses were employed to screen the independent risk factors of the PE in sICH patients. A nomogram model (Model P-P) was constructed based on R language and subsequently validated. For further evaluation, the Model P-P was compared with another similar model (Model A).

Results The analyses revealed that deep vein thrombosis, age, Glasgow coma scale score, fibrinogen degradation product, D-dimer, hemoglobin, hemorrhage volume, plasma osmolality, and surgical method were significant risk factors for PE in sICH patients (p<0.05). The Model P-P was established based on these factors, and its sensitivity, specificity were 84.2%, 94% and 0.910, respectively. Furthermore, the AUC of Model P-P (0.894) was significantly higher than that of Model A (0.785) (p<0.05).

Conclusion The Model P-P developed in this study exhibited reliable predictive efficiency, making it an applicable tool for the early evaluation and prediction of PE after sICH surgery. This model is potential to assist personalized treatment decisions in clinical practice, especially in the neurosurgical intensive care unit.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The authors declare financial support was received for the research, authorship, and publication of this article. This work was supported by the Chongqing Medical Scientific Research Project (joint project of Chongqing Health Commission and Science and Technology Bureau) (2022MSXM041 and 2024MSXM077), the CQMU Program for Youth Innovation in Future Medicine (Scientific Research and Innovation Team, No. W0169), the National Natural Science Foundation for Youth of China (No. 81701226), the 2023 Chongqing Technology Innovation and Application Development Special Science and Technology Assistance to Tibet and Xinjiang Project (CSTB2023TIAD-KPX0001), and 2023 Natural Science Foundation of Xizang Autonomous Region [XZ2023ZR-ZY67 (Z)], and Chongqing Natural Science Foundation General Project (No. CSTB2022NSCQ-MSX0152).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study received approval from the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (K2023-581).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The datasets generated and analyzed during the current study are not publicly available due privacy /ethical restrictions but are available from the corresponding author on reasonable request.

AbbreviationsAPTTActivated partial thromboplastin timeAUCArea under the curveBMIBody mass indexCTPAComputed tomographic pulmonary angiographyDCADecision curves analysisDDD-dimerDVTDeep vein thrombosisFDPFibrin degradation productsGCSGlasgow Coma ScaleNICUneurosurgical intensive care unitPEPulmonary embolismPTprothrombin timeROCReceiver operating characteristicsICHSpontaneous intracerebral hemorrhage