Development and Internal Validation of an Inflammatory-Coagulation Biomarker-Enhanced Nomogram for 90-Day Outcome After Deep Hypertension-Related Intracerebral Hemorrhage.

Abstract

Background: Early prognostic assessment after intracerebral hemorrhage (ICH) relies mainly on neurological severity and neuroimaging features. Whether routinely available inflammatory-coagulation biomarkers provide meaningful incremental information beyond these established predictors remains uncertain.

Objective: To develop and internally validate an admission-based nomogram incorporating inflammatory-coagulation biomarkers for predicting 90-day poor functional outcome in patients with deep hypertension-related ICH.

Methods: This single-center retrospective cohort study included consecutive patients with deep hypertension-related ICH admitted between January 2020 and December 2025. Poor functional outcome was defined as a 90-day modified Rankin Scale score of 4-6. Candidate predictors available within 24 hours of admission were evaluated using least absolute shrinkage and selection operator logistic regression followed by multivariable logistic regression. Model performance was assessed using discrimination, calibration, Brier score, bootstrap internal validation, reclassification metrics, and decision curve analysis.

Results: Among 462 patients, 162 (35.1%) had poor functional outcome. The final model retained age, Glasgow Coma Scale score, hematoma volume, intraventricular hemorrhage, admission blood glucose, neutrophil-to-lymphocyte ratio, and ln(D-dimer). Adding NLR and ln(D-dimer) increased the AUC from 0.765 to 0.828 (P = 0.008), representing a statistically significant but modest absolute improvement of 0.063, and reduced the Brier score from 0.178 to 0.142. The optimism-corrected AUC was 0.816. Decision curve analysis showed greater net benefit than the conventional model across threshold probabilities of 15%-65%. Sensitivity analyses yielded consistent biomarker associations and model performance.

Conclusion: Adding NLR and D-dimer to established clinical-imaging predictors provided a modest improvement in 90-day outcome prediction in deep hypertension-related ICH. These biomarkers may offer complementary prognostic information, but the clinical importance of this incremental gain remains to be established. External validation is required before broader clinical application.