Clinical Research

Analysis of coagulation and fibrinolysis biomarkers for prognostic assessment and clinical efficacy evaluation in patients with intracerebral hemorrhage

  • Shouping LIU ,
  • Yinlin TANG ,
  • Yanfang CHENG ,
  • Qian ZHOU
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  • Department of Laboratory Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong,China

Received date: 2025-03-08

  Online published: 2025-07-02

Abstract

Objective To explore the prognostic implications of coagulation-fibrinolysis biomarkers in intracerebral hemorrhage (ICH) and to construct a multivariable logistic regression model for individualized risk prediction. Methods A total of 101 ICH patients who were admitted to Nanfang Hospital of Southern Medical University from January 2020 to December 2023 were retrospectively enrolled. These patients were stratified into a poor outcome group (ΔGCS ≤ 0) and a good outcome group (ΔGCS > 0) according to the difference in Glasgow Coma Scale (GCS) scores between discharge and admission. Coagulation and fibrinolysis markers collected upon admission were analyzed. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to screen variables. A logistic regression model was constructed using 70% of the cases (the training set), while the remaining 30% were utilized for validation. The performance of the model was evaluated through receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA). Results Univariate analysis indicated that thrombin-antithrombin complex (TAT), D-dimer, and age exhibited significant differences between the two outcome groups (P < 0.05). These three variables were selected via LASSO regression and incorporated into the logistic model. The final model equation was expressed as: logit(P) = -6.234 + 1.132 × TAT + 0.867 × D-dimer + 0.699 × Age. In the training set, the area under the ROC curve (AUC) was 0.795. The calibration curve demonstrated excellent agreement between the predicted and observed outcomes, with a Hosmer-Lemeshow test P-value of 0.8568. DCA revealed that the model achieved net clinical benefit across a broad range of risk thresholds (0.1 ~ 0.8). Conclusions TAT, D-dimer, and age are independent predictors of poor prognosis in patients with ICH. The logistic regression model based on these variables demonstrates favorable discriminatory ability and clinical utility. The nomogram derived from this model enables individualized risk assessment and may aid clinicians in early prognostic evaluation and treatment planning.

Cite this article

Shouping LIU , Yinlin TANG , Yanfang CHENG , Qian ZHOU . Analysis of coagulation and fibrinolysis biomarkers for prognostic assessment and clinical efficacy evaluation in patients with intracerebral hemorrhage[J]. The Journal of Practical Medicine, 2025 , 41(12) : 1846 -1852 . DOI: 10.3969/j.issn.1006-5725.2025.12.011

References

1 WANG Y J, LI Z X, GU H Q, et al. China Stroke Statistics 2019: A Report From the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations[J]. Stroke Vasc Neurol, 2020, 5(3): 211-239. doi:10.1136/svn-2020-000457
2 李元贵,杨燕文,王晓麒,等. 软通道血肿穿刺引流术与神经内镜颅内血肿清除术治疗高血压脑出血的疗效[J]. 实用医学杂志, 2023, 39(7): 833-837.
3 彭天忠,黄学娣,林星镇,等. 开窍醒神针法联合加味补阳还五汤对脑出血恢复期患者(气虚血瘀证)IL-2、MMP-9、BDNF及脑血流量的影响[J]. 实用医学杂志, 2025, 41(3): 428-433.
4 WU S, WU B, LIU M, et al. Stroke in China: Advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi:10.1016/s1474-4422(18)30500-3
5 FEIGIN V L, FOROUZANFAR M H, KRISHNAMURTHI R, et al. Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010[J]. Lancet, 2014, 383(9913): 245-254. doi:10.1016/s0140-6736(13)61953-4
6 VAN ASCH C J, LUITSE M J, RINKEL G J, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: A systematic review and meta-analysis[J]. Lancet Neurol, 2010, 9(2): 167-176. doi:10.1016/s1474-4422(09)70340-0
7 TSAI C F, THOMAS B, SUDLOW C L. Epidemiology of stroke and its subtypes in Chinese vs white populations: A systematic review[J]. Neurology, 2013, 81(3): 264-272.
8 LIU M, WU B, WANG W Z, et al. Stroke in China: Epidemiology, prevention, and management strategies[J]. Lancet Neurol, 2007, 6(5): 456-464.
9 SACCO S, MARINI C, TONI D, et al. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry[J]. Stroke, 2009, 40(2): 394-399. doi:10.1161/strokeaha.108.523209
10 DELGADO P, ALVAREZ-SABíN J, ABILLEIRA S, et al. Plasma D-dimer predicts poor outcome after acute intracerebral hemorrhage[J]. Neurology, 2006, 67(1): 94-98.
11 ZHOU Q, ZHANG D, CHEN X, et al. Plasma D‐dimer predicts poor outcome and mortality after spontaneous intracerebral hemorrhage[J]. Brain Behav, 2021, 11(1): 462-468.
12 JOHANSSON K, JANSSON J H, JOHANSSON L, et al. D-dimer Is Associated With First-Ever Intracerebral Hemorrhage[J]. Stroke, 2018, 49(9): 2034-2039. doi:10.1161/strokeaha.118.021751
13 王子文,赵文静,晁亚丽. D-二聚体、乳酸联合可溶性血小板内皮黏附分子-1对脓毒症相关弥散性血管内凝血患者预后不良的预测研究[J]. 实用医学杂志, 2023, 39(18): 2379-2383.
14 HU X, FANG Y, YE F, et al. Effects of plasma D-dimer levels on early mortality and long-term functional outcome after spontaneous intracerebral hemorrhage[J]. J Clin Neurosci, 2014, 21(8): 1364-1367.
15 FUJII Y, TAKEUCHI S, HARADA A, et al. Hemostatic activation in spontaneous intracerebral hemorrhage[J]. Stroke, 2001, 32(4): 883-890.
16 郭晓敏, 王雪婷, 刘振明. 凝血功能检测在脑出血患者预后评估中的应用价值分析[J]. 中华养生保健, 2022, 40(2): 155-156.
17 任娟. 对脑出血患者进行凝血功能检查在评估其预后方面的价值[J]. 当代医药论丛, 2018, 16(15): 76-77.
18 李健, 禇荣涛, 张志越, 等. 凝血功能检测在脑出血患者预后评估中的应用价值[J]. 智慧健康, 2023, 9(19): 101-104.
19 NINA P, SCHISANO G, CHIAPPETTA F, et al. A study of blood coagulation and fibrinolytic system in spontaneous subarachnoid hemorrhage. Correlation with Hunt-Hess grade and outcome[J]. Surg Neurol, 2001, 55(4): 197-203.
20 FEIGIN V L, LAWES C M, BENNETT D A, et al. Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century[J]. Lancet Neurol, 2003, 2(1): 43-53. doi:10.1016/s1474-4422(03)00266-7
21 国家卫生健康委办公厅. 中国脑卒中防治指导规范(2021年版). [EB/OL].(2021-08-31)[2025-03-31].
22 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12): 994-1005.
23 WU C H, YANG R L, HUANG S Y, et al. Analysis of thrombin-antithrombin complex contents in plasma and hematoma fluid of hypertensive intracerebral hemorrhage patients after clot removal[J]. Eur J Neurol, 2011, 18(8): 1060-1066.
24 WU C, YAN X, LIAO Y, et al. Increased perihematomal neuron autophagy and plasma thrombin-antithrombin levels in patients with intracerebral hemorrhage: An observational study[J]. Medicine, 2019, 98(39): e17130.
25 WAN Y, HOLSTE K G, HUA Y, et al. Brain edema formation and therapy after intracerebral hemorrhage[J]. Neurobiol Dis, 2023, 176:105948.
26 CHEN S, LI L, PENG C, et al. Targeting oxidative stress and inflammatory response for blood-brain barrier protection in intracerebral hemorrhage[J]. Antioxid Redox Signal, 2022, 37(1-3): 115-134. doi:10.1089/ars.2021.0072
27 LAURIDSEN S V, HVAS A M, SANDGAARD E, et al. Coagulation profile after spontaneous intracerebral hemorrhage: A cohort study[J]. J Stroke Cerebrovasc Dis, 2018, 27(11): 2951-2961.
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