• Kun Lin, Zhi-Yun Zhan, Yong-Xiu Tong, Zhi-Cheng Lin, Yin-Hai Tang, and Yuan-Xiang Lin.
• Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
• Neurocrit Care. 2025 Feb 7.

BackgroundEarly postoperative cerebral infarction (ePCI) significantly worsens outcomes in patients with spontaneous intracerebral hemorrhage (ICH) undergoing surgery. This study aimed to develop and externally validate a nomogram to assess ePCI risk.MethodsAdult patients with spontaneous supratentorial ICH who underwent surgery between May 2015 and September 2022 at a large tertiary referral center (development cohort) and another tertiary referral center (external validation cohort) were retrospectively included. ePCI was defined as a newly identified permanent low-density lesion observed within 72 h of surgery on computed tomography. We developed a nomogram using predictors identified through least absolute shrinkage and selection operator analysis. The model's discrimination, calibration, and clinical utility were evaluated.ResultsThe development cohort (n = 453) had 51 ePCI cases, and the external validation cohort (n = 184) had 20. The model incorporated the Glasgow Coma Scale (GCS), the Original Intracerebral Hemorrhage Scale (oICH), uncal herniation stage, and hematoma volume, demonstrating strong discrimination with an area under the receiver operating characteristic curve (AUC) of 0.915 (95% confidence interval [CI] 0.882-0.948) in the development cohort and an AUC of 0.942 (95% CI 0.897-0.988) in the external independent cohort. The model also showed excellent calibration and clinical applicability.ConclusionsThis nomogram, including the GCS, the oICH, uncal herniation stage, and hematoma volume, effectively predicts ePCI risk in patients with spontaneous supratentorial ICH.© 2025. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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