Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study
Shan Chong, Peng Zhao, Ruibin Huang, Hu Zhou, Jianing Zhang, Ming Hou, Yi Liu, Hongxia Yao, Ting Niu, Jun Peng, Ming Jiang, Yanqiu Han, Jianda Hu, Zeping Zhou, Lin Qiu, Liansheng Zhang, Xin Wang, Huaquan Wang, Ru Feng, Linhua Yang, Liangming Ma, Shunqing Wang, Peiyan Kong, Wensheng Wang, Huiping Sun, Jing Sun, Hebing Zhou, Tienan Zhu, Liru Wang, Jingyu Zhang, Qiu-Sha Huang, Hai‐Xia Fu, Yejun Wu, Yueying Li, Qian‐Fei Wang, Qian Jiang, Hao Jiang, Jin Lu, Xiao‐Jun Huang, Xiaohui Zhang
Abstract
Intracranial hemorrhage (ICH) is a rare and life-threatening hemorrhagic event in patients with immune thrombocytopenia (ITP). However, its mortality and related risk factors remain unclear. Herein, we conducted a nationwide multicenter real-world study of ICH in adult ITP patients. According to data from 27 centers in China from 2005 to 2020, the mortality rate from ICH was 33.80% (48/142) in ITP adults. We identified risk factors by logistic univariate and multivariate logistic regression for 30-day mortality in a training cohort of 107 patients as follows: intraparenchymal hemorrhage (IPH), platelet count ≤10 × 109/L at ICH, a combination of serious infections, grade of preceding bleeding events, and Glasgow coma scale (GCS) level on admission. Accordingly, a prognostic model of 30-day mortality was developed based on the regression equation. Then, we evaluated the performance of the prognostic model through a bootstrap procedure for internal validation. Furthermore, an external validation with data from a test cohort with 35 patients from 11 other centers was conducted. The areas under the receiver operating characteristic (ROC) curves for the internal and external validation were 0.954 (95% confidence interval [CI], 0.910-0.998) and 0.942 (95% CI, 0.871-1.014), respectively. Both calibration plots illustrated a high degree of consistency in the estimated and observed risk. In addition, the decision curve analysis showed a considerable net benefit for patients. Thus, an application (47.94.162.105:8080/ich/) was established for users to predict 30-day mortality when ICH occurred in adult patients with ITP.