Value of mismatch negativity combined with the full outline of unresponsiveness score in predicting the prognosis of elderly patients with hypertensive intracerebral hemorrhage

doi:10.3877/cma.j.issn.1673-9248.2026.04.009

Abstract

Abstract:

Objective

To investigate the value of mismatch negativity (MMN) latency, and amplitude combined with full outline of unresponsiveness scale (FOUR) score in the prognosis of elderly patients with hypertensive intracerebral hemorrhage (HICH).

Methods

This prospective study enrolled 155 elderly patients with HICH admitted to Handan Central Hospital from January 2022 to August 2024. Patients were followed up for 3 months post-discharge and stratified into a favorable prognosis group [modified Rankin scale (mRS) ≤2] and a poor prognosis group (mRS ＞2). All patients underwent MMN latency and amplitude measurements and were assessed using the FOUR score. The clinical data were collected and compared between groups. Multivariate Logistic regression was performed to identify independent predictors of poor prognosis. The predictive performance of MMN latency, MMN amplitude, FOUR score, and Glasgow coma scale (GCS) was evaluated using receiver operating characteristic (ROC) curve analysis, and DeLong tests were used to compare areas under the curve (AUC).

Results

Of the 155 patients, 104 had favorable outcomes and 51 had poor outcomes. Compared with the favorable prognosis group, the poor prognosis group showed a prolonged MMN latency [(275.69±19.85) ms vs (240.71±28.66) ms, t=7.837, P＜0.001], decreased MMN amplitude [(0.85±0.36) μV vs (1.49±0.57) μV, t=8.503, P＜0.001], lower FOUR scores (5.96±1.76 vs 9.35±2.24, t=9.464, P＜0.001), and lower GCS (7.54±3.03 vs 10.75±3.87, t=5.191, P＜0.001). Multivariate Logistic regression analysis showed that a prolonged MMN latency was a risk factor for poor prognosis in elderly HICH patients (OR=1.664, 95%CI: 1.267 - 2.185, P＜0.001), while elevated GCS (OR=0.805, 95%CI: 0.680 - 0.953, P=0.011), high MMN amplitude (OR=0.513, 95%CI: 0.315 - 0.836, P=0.007), and high FOUR score (OR=0.682, 95%CI: 0.550 - 0.846, P＜0.001) were independent protective factors. The combined model of MMN latency, amplitude, FOUR score, and GCS yielded an AUC of 0.903 (sensitivity 90.2%, specificity 85.7%) for predicting poor prognosis, which was significantly higher than any single parameter (AUCs: 0.712, 0.725, 0.773, and 0.660, respectively).

Conclusion

Prolonged MMN latency, decreased MMN amplitude, decreased FOUR score, and decreased GCS are significantly associated with poor prognosis in elderly HICH patients. The combination of these four parameters has high predictive value for identifying patients at risk for poor outcomes.

Key words: Hypertensive intracerebral hemorrhage, Mismatch negativity, Full outline of unresponsiveness scale, Prognosis

Xiaoguang Lang, Yuqin Zhao, Zhixing Yao, Sui Tian, Yuemin Gao, Ying Lyu, Xuehai Lyu. Value of mismatch negativity combined with the full outline of unresponsiveness score in predicting the prognosis of elderly patients with hypertensive intracerebral hemorrhage[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(04): 411-417.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2026.04.009

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Figures/Tables 4

因素	预后良好组（n=104）	预后不良组（n=51）	统计值	P值
性别[例（%）]			χ²=1.892	0.169
男	66（63.46）	38（74.51）
女	38（36.54）	13（25.49）
年龄（岁， $x ¯$ ±s）	68.20±6.94	69.01±7.17	t=-0.675	0.500
高血压病程（年， $x ¯$ ±s）	9.89±1.73	10.33±2.06	t=-1.396	0.165
GCS（分， $x ¯$ ±s）	10.75±3.87	7.54±3.03	t=5.191	＜0.001
合并症[例（%）]
糖尿病	21（20.19）	16（31.37）	χ²=2.354	0.125
高脂血症	29（27.88）	18（35.29）	χ²=0.889	0.346
冠心病	12（11.54）	9（17.65）	χ²=1.090	0.296
出血部位[例（%）]			χ²=3.719	0.285
丘脑	23（22.12）	11（21.57）
脑干	17（16.35）	14（27.45）
基底节区	53（50.96）	19（37.25）
其他	11（10.58）	7（13.73）
手术方式[例（%）]			χ²=1.313	0.252
开颅血肿清除术	53（50.96）	21（41.18）
神经内镜血肿清除术	51（49.04）	30（58.82）
手术时间[例（%）]			χ²=3.351	0.067
＞7 h	55（52.88）	19（37.25）
≤7 h	49（47.12）	32（62.75）
脑出血量（mL， $x ¯$ ±s）	24.39±2.13	26.06±2.64	t=-4.231	＜0.001
收缩压（mmHg， $x ¯$ ±s）	172.15±15.75	176.43±17.41	t=-1.535	0.127
舒张压（mmHg， $x ¯$ ±s）	105.96±7.75	108.35±9.07	t=-1.704	0.090
WBC（×10⁹ /L， $x ¯$ ±s）	8.96±1.45	9.34±1.21	t=-1.615	0.108
MMN潜伏期（ms， $x ¯$ ±s）	240.71±28.66	275.69±19.85	t=7.837	＜0.001
MMN波幅（μV， $x ¯$ ±s）	1.49±0.57	0.85±0.36	t=8.503	＜0.001
FOUR评分（分， $x ¯$ ±s）	9.35±2.24	5.96±1.76	t=9.464	＜0.001

因素	预后良好组（n=104）	预后不良组（n=51）	统计值	P值
性别[例（%）]			χ²=1.892	0.169
男	66（63.46）	38（74.51）
女	38（36.54）	13（25.49）
年龄（岁， $x ¯$ ±s）	68.20±6.94	69.01±7.17	t=-0.675	0.500
高血压病程（年， $x ¯$ ±s）	9.89±1.73	10.33±2.06	t=-1.396	0.165
GCS（分， $x ¯$ ±s）	10.75±3.87	7.54±3.03	t=5.191	＜0.001
合并症[例（%）]
糖尿病	21（20.19）	16（31.37）	χ²=2.354	0.125
高脂血症	29（27.88）	18（35.29）	χ²=0.889	0.346
冠心病	12（11.54）	9（17.65）	χ²=1.090	0.296
出血部位[例（%）]			χ²=3.719	0.285
丘脑	23（22.12）	11（21.57）
脑干	17（16.35）	14（27.45）
基底节区	53（50.96）	19（37.25）
其他	11（10.58）	7（13.73）
手术方式[例（%）]			χ²=1.313	0.252
开颅血肿清除术	53（50.96）	21（41.18）
神经内镜血肿清除术	51（49.04）	30（58.82）
手术时间[例（%）]			χ²=3.351	0.067
＞7 h	55（52.88）	19（37.25）
≤7 h	49（47.12）	32（62.75）
脑出血量（mL， $x ¯$ ±s）	24.39±2.13	26.06±2.64	t=-4.231	＜0.001
收缩压（mmHg， $x ¯$ ±s）	172.15±15.75	176.43±17.41	t=-1.535	0.127
舒张压（mmHg， $x ¯$ ±s）	105.96±7.75	108.35±9.07	t=-1.704	0.090
WBC（×10⁹ /L， $x ¯$ ±s）	8.96±1.45	9.34±1.21	t=-1.615	0.108
MMN潜伏期（ms， $x ¯$ ±s）	240.71±28.66	275.69±19.85	t=7.837	＜0.001
MMN波幅（μV， $x ¯$ ±s）	1.49±0.57	0.85±0.36	t=8.503	＜0.001
FOUR评分（分， $x ¯$ ±s）	9.35±2.24	5.96±1.76	t=9.464	＜0.001

因素	回归变量赋值	β值	SE值	Wald χ²值	P值	OR值	95%CI
常数	-	-0.203	0.099	4.168	0.041	-	-
GCS	≥10分=1，＜10分=0	-0.217	0.086	6.401	0.011	0.805	0.680~0.953
脑出血量	连续变量	0.435	0.262	2.603	0.082	1.797	1.075~3.003
MMN潜伏期	≥250 ms=1，否=0	0.509	0.139	13.339	＜0.001	1.664	1.267~2.185
MMN波幅	≥1.1 μV=1，否=0	-0.667	0.249	7.162	0.007	0.513	0.315~0.836
FOUR评分	≥7分=1，否=0	-0.383	0.110	12.162	＜0.001	0.682	0.550~0.846

指标	阈值	AUC	95%CI	敏感度（%）	特异度（%）	约登指数	准确度
GCS	10分	0.660	0.412~0.913	66.7	65.7	0.324	0.660
MMN潜伏期	250 ms	0.712	0.449~0.968	68.6	73.3	0.419	0.718
MMN波幅	1.1 μV	0.725	0.521~0.923	76.5	67.6	0.441	0.705
FOUR评分	7分	0.773	0.574~0.959	78.4	74.3	0.527	0.756
联合模型	-	0.903	0.808~0.975	90.2	85.7	0.759	0.872

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