Construction of a Nomogram for Predicting ICU Mortality Risk in Patients with Spinal Fractures Based on the APACHE IV

This study aimed to develop and validate a nomogram for predicting ICU mortality risk in patients with spinal fractures to improve prognostic accuracy. Using data from 1,146 patients in the eICU Collaborative Research Database, independent risk factors—including age, BMI, APACHE IV score, admission source, mechanical ventilation, spinal cord injury, sepsis, oxygen saturation, white blood cell count, hemoglobin, and glucose—were identified via forward stepwise logistic regression and incorporated into the nomogram. The model demonstrated excellent performance, with AUCs of 0.902 (0.857–0.938) in the training cohort and 0.903 (0.825–0.953) in the validation cohort, significantly outperforming APACHE IV according to the DeLong test. Further validation via Hosmer-Lemeshow test, calibration curves, NRI, IDI, and DCA confirmed the nomogram’s superior calibration and clinical utility. As the first comprehensive predictive tool of its kind for spinal fracture patients, this nomogram offers improved mortality risk estimation and supports clinical decision-making.