Risk prediction model and survival analysis of adult patients with intracranial hemorrhage in acute leukemia

This study aimed to identify the clinical characteristics, risk factors, and prognostic determinants of intracranial hemorrhage (ICH) in adult patients with acute leukemia (AL). We conducted a retrospective analysis of 3751 AL patients (aged ≥14 years) treated at our institution between 2010 and 2024. Independent risk factors for ICH included AL subtype, platelet count (PLT) <50 × 10⁹/L, leukocytosis (WBC >100 × 10⁹/L), elevated lactate dehydrogenase (LDH >245 IU/L), and prolonged prothrombin time (PT ≥3 s). The median overall survival (OS) in the ICH group was markedly shorter than in the NICH group (1.0 vs. 38.0 months, p < 0.001). Among non-APL patients, leukocytosis (WBC >100 × 10⁹/L), thrombocytopenia (PLT <50 × 10⁹/L), APTT prolongation ≥10 s, and increased D-dimer (DDI) level (≥9 μg/mL) were independent risk factors for ICH, while increased DDI level (≥9 μg/mL) was associated with poor prognosis. These findings emphasize the importance of early risk stratification and targeted interventions to reduce the risk of ICH.