Development and internal-external validation of a risk prediction nomogram for secondary myocardial injury in traumatic brain injury.

Overview

1. The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
2. Department of Cardiovascular Medicine, Heart Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China

Abstract

Introduction: Traumatic Brain Injury (TBI)-induced secondary myocardial injury (SMI) is a severe complication with poor prognosis, but reliable early predictive tools are lacking. This study aimed to develop and validate a nomogram for predicting this risk in TBI patients admitted to the intensive care unit (ICU).

Methods: We retrospectively analyzed 1,042 ICU-admitted TBI patients without pre-existing cardiac disease from the MIMIC-IV database, randomly divided into training (n = 729) and internal validation (n = 313) sets at a 7:3 ratio. An external validation cohort of 200 patients from Zhejiang Provincial People’s Hospital (2020–2025) was also included. Five key predictors were identified via univariate and multivariate logistic regression.

Results: The final model included blood urea nitrogen, hemoglobin, Sequential Organ Failure Assessment (SOFA) score, serum potassium, and creatinine. It showed good discriminative ability: training set AUC = 0.772 (95%CI: 0.737–0.808), internal validation set AUC = 0.785 (95%CI: 0.733–0.837), and external validation set AUC = 0.848 (95%CI: 0.778–0.917).

Conclusions and discussion: This nomogram, based on easily accessible clinical parameters, enables early risk stratification of SMI in TBI patients before cardiac biomarker elevation, providing a practical tool for targeted clinical monitoring and intervention.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Data

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• physionet.org/content/mimiciv, at PhysioNet; found in the end of the paper

Data availability statement

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Version 1, 30 September 2026: the first record

Recorded: type, language, journal, volume, pages, dates, 4 authors, 5 keywords, 50 references.

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This paper

Zhan, Y.-Q., Wu, C.-y., Shen, Y.-b., & Ding, Y.-h. (2026). Development and internal-external validation of a risk prediction nomogram for secondary myocardial injury in traumatic brain injury. Frontiers in neurology, 17, 1770629. https://doi.org/10.3389/fneur.2026.1770629

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