BACKGROUND Large hemispheric infarction (LHI) is a severe form of stroke with high mortality and disability rates. The purpose of this study was to explore predictive indicators of the in-hospital mortality of LHI patients treated conservatively without decompressive hemicraniectomy. METHOD We performed a retrospective study of 187 consecutive patients with LHI between January 1, 2016 to May 31, 2019. The receiver operating curves were preformed to evaluate predictive performance of demographics factors, biomarkers and radiologic characteristics. Significant prognostic factors were combined to build a nomogram to predict the risk of in-hospital death of individual patients. RESULT One hundred fifty-eight patients with LHI were finally enrolled, 58 of which died. Through multivariate logistic regression analysis, we identified that independent prognostic factors for in-hospital death were age (adjusted odds ratio [aOR] = 1.066; 95% confidence interval [CI], 1.025-1.108; P = 0.001), midline shift (MLS, aOR = 1.330, 95% CI, 1.177-1.503; P <  0.001), and neutrophil-to-lymphocyte ratio (NLR, aOR = 3.319, 95% CI, 1.542-7.144; P = 0.002). NLR may serve as a better predictor than white blood count (WBC) and neutrophil counts. Lastly, we used all of the clinical characteristics to establish a nomogram for predicting the prognosis, area under the curve (AUC) of this nomogram was 0.858 (95% CI, 0.794-0.908). CONCLUSION This study shows that age, MLS, and admission NLR value are independent predictors of in-hospital mortality in patients with LHI. Moreover, nomogram, serve as a precise and convenient tool for the prognosis of LHI patients.

中文翻译：

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预测大半球性脑梗死后住院死亡率的列线图。

背景技术大半球性脑梗塞（LHI）是中风的一种严重形式，具有高死亡率和致残率。这项研究的目的是探讨保守的LHI患者未经减压半椎切除术的院内死亡率的预测指标。方法我们对2016年1月1日至2019年5月31日之间的187例LHI进行了回顾性研究。绘制受试者工作曲线以评估人口统计学因素，生物标志物和放射学特征的预测性能。结合重要的预后因素建立诺模图，以预测个别患者住院死亡的风险。结果158例LHI患者最终入组，其中58例死亡。通过多元逻辑回归分析，我们确定院内死亡的独立预后因素是年龄（校正比值比[aOR] = 1.066； 95％置信区间[CI]，1.025-1.108； P = 0.001），中线移位（MLS，aOR = 1.330，95） ％CI，1.177-1.503； P ＜0.001），以及中性粒细胞与淋巴细胞的比率（NLR，aOR ＝ 3.319，95％CI，1.542-7.144； P ＝ 0.002）。与白细胞计数（WBC）和中性粒细胞计数相比，NLR可能是更好的预测指标。最后，我们使用所有临床特征建立了可预测预后的诺模图，该诺模图的曲线下面积（AUC）为0.858（95％CI，0.794-0.908）。结论本研究表明，年龄，MLS和入院NLR值是LHI患者住院死亡率的独立预测因子。此外，列线图是LHI患者预后的一种精确而便捷的工具。