Objective:To preliminarily construct and apply a longitudinal trajectory model for the prognosis of intracerebral hemorrhage(ICH)based on blood urea nitrogen(BUN)characteristics.Methods:Clinical data from 320 ICH pati...Objective:To preliminarily construct and apply a longitudinal trajectory model for the prognosis of intracerebral hemorrhage(ICH)based on blood urea nitrogen(BUN)characteristics.Methods:Clinical data from 320 ICH patients admitted to our hospital between 2020 and 2024 were collected,including demographic information,National Institutes of Health Stroke Scale(NIHSS)scores at admission,dynamic changes in BUN levels during treatment,and 30-day survival outcomes.A latent class growth model(LCGM)was first used for preliminary modeling,followed by a latent growth mixture modeling(GMM)approach to determine the final model.Three classes of BUN trajectories for ICH prognosis were identified,and latent classes were established.GMM modeling was then performed on these latent classes,considering linear,quadratic,and cubic polynomial forms;six GMM models were constructed and individuals were assigned to latent trajectory groups for validation.Results:LCGM analysis ultimately identified three dynamic BUN trajectory groups:Sustained low-level group(76 cases,23.8%):BUN remained stable between 3.1-9.0 mmol/L,with the highest 30-day survival rate(98.7%).Fluctuating-declining group(222 cases,69.4%):BUN initially increased and then slowly decreased(peak at day 3:15.2 mmol/L),with a 30-day mortality of 8.1%(18/222),higher than the sustained low-level group.Sustained high-level group(22 cases,6.9%):BUN mean>9.0 mmol/L,with a 30-day mortality of 41.7%(P=0.000).GMM model fitting showed that the cubic polynomial GMM model was optimal(AIC=6754.474,BIC=6852.450,Entropy=0.905).Incorporating gender,age,and BMI as covariates revealed significant effects for gender(Estimate=0.045,-0.011,P=0.000,0.000).The AUC for predicting 30-day mortality was 0.88(sensitivity 82.8%,specificity 77.9%),which increased to 0.89 when combined with admission NIHSS scores.Conclusion:The LCGM+GMM model based on dynamic BUN trajectories effectively distinguishes prognostic subgroups in ICH patients.Patients with persistently elevated or fluctuating-rising BUN levels have a significantly higher mortality risk compared to those with sustained low levels.This model provides a new quantitative tool for early identification of high-risk patients and poor prognoses.展开更多
文摘Objective:To preliminarily construct and apply a longitudinal trajectory model for the prognosis of intracerebral hemorrhage(ICH)based on blood urea nitrogen(BUN)characteristics.Methods:Clinical data from 320 ICH patients admitted to our hospital between 2020 and 2024 were collected,including demographic information,National Institutes of Health Stroke Scale(NIHSS)scores at admission,dynamic changes in BUN levels during treatment,and 30-day survival outcomes.A latent class growth model(LCGM)was first used for preliminary modeling,followed by a latent growth mixture modeling(GMM)approach to determine the final model.Three classes of BUN trajectories for ICH prognosis were identified,and latent classes were established.GMM modeling was then performed on these latent classes,considering linear,quadratic,and cubic polynomial forms;six GMM models were constructed and individuals were assigned to latent trajectory groups for validation.Results:LCGM analysis ultimately identified three dynamic BUN trajectory groups:Sustained low-level group(76 cases,23.8%):BUN remained stable between 3.1-9.0 mmol/L,with the highest 30-day survival rate(98.7%).Fluctuating-declining group(222 cases,69.4%):BUN initially increased and then slowly decreased(peak at day 3:15.2 mmol/L),with a 30-day mortality of 8.1%(18/222),higher than the sustained low-level group.Sustained high-level group(22 cases,6.9%):BUN mean>9.0 mmol/L,with a 30-day mortality of 41.7%(P=0.000).GMM model fitting showed that the cubic polynomial GMM model was optimal(AIC=6754.474,BIC=6852.450,Entropy=0.905).Incorporating gender,age,and BMI as covariates revealed significant effects for gender(Estimate=0.045,-0.011,P=0.000,0.000).The AUC for predicting 30-day mortality was 0.88(sensitivity 82.8%,specificity 77.9%),which increased to 0.89 when combined with admission NIHSS scores.Conclusion:The LCGM+GMM model based on dynamic BUN trajectories effectively distinguishes prognostic subgroups in ICH patients.Patients with persistently elevated or fluctuating-rising BUN levels have a significantly higher mortality risk compared to those with sustained low levels.This model provides a new quantitative tool for early identification of high-risk patients and poor prognoses.
