A web based dynamic MANA Nomogram for predicting the malignant cerebral edema in patients with large hemispheric infarction

BMC Neurology

Zhou Zhu¹  Guo Li¹  Xiaoyan Song¹  Jinfeng Miao¹  Xiuli Qiu¹  Suiqiang Zhu¹  Wenzhe Sun¹  Yan Lan¹  Zhaoxia Yang²  Yebin Fan³  Yang Song⁴  Yuxi Chen⁵ 

[1] Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, 430030, Wuhan, China;Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, 430030, Wuhan, China;School of Computer Science and Technology, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, 430030, Wuhan, China;School of Medicine and Health Management; Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China;The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, 21205, Baltimore, MD, USA;

关键词: Ischemic stroke;    Large hemispheric infarction;    Brain edema;    Nomogram;    Atrial fibrillation;   

DOI  :  10.1186/s12883-020-01935-6

来源: Springer

【 摘 要 】

BackgroundFor large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE.MethodsOne hundred forty-two consecutive patients with LHI within 24 h of onset between January 1, 2016 and August 31, 2019 were retrospectively reviewed. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5 mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction.ResultsAfter adjusting for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the nomogram use for clinicians, we used the “Dynnom” package to build a dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The MANA nomogram’s C-statistic was up to 0.887 ± 0.041 and the AUC-ROC value in this cohort was 0.887 (95%CI, 0.828 ~ 0.934).ConclusionsIndependent MCE predictors included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

【 授权许可】

CC BY