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A prognostic nomogram for all frequencies sudden sensorineural hearing loss based on the commixed index of inflammatory–immune–hemostasis–nutrition
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  • Published: 01 April 2026

A prognostic nomogram for all frequencies sudden sensorineural hearing loss based on the commixed index of inflammatory–immune–hemostasis–nutrition

  • Zhong Zheng1,2,3 na1,
  • Liang Xia1,2 na1,
  • Xiaoyan Chen1,2 na1,
  • Yi Chen1,2,
  • Kexin Song1,2,
  • Lili Xiao1,2,
  • Niannian Li1,2,
  • Fuquan Chen3,
  • Hui Li4 &
  • …
  • Yanmei Feng1,2 

Scientific Reports , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Biomarkers
  • Neurological disorders
  • Outcomes research

Abstract

All-frequencies sudden sensorineural hearing loss (AF-SSNHL) is a common otology emergency that greatly impacts patient’s quality of life. Given that inflammatory-immune-hemostasis-nutrition-related parameters are commonly reported prognostic factors, this study aimed to compare and evaluate the clinical value of such parameters to develop a prognostic nomogram. The analysis prospectively enrolled 245 patients with AF-SSNHL patients from August 2018 to May 2022. Patients were divided into training and validation cohorts randomly. The predictive values of the hematological indexes were calculated by receiver operating characteristic analysis, and predictive abilities were evaluated using logistic regression. A predictive prognostic model was developed using logistic regression and internally/external validated using calibration curves, decision curve analysis, and ROC analysis; a nomogram was constructed as its graphical representation. The prognostic nutritional index (PNI) and neutrophil lymphocyte D-dimer albumin score (NLDA) were superior to other hematological indexes in predicting the outcome of AF-SSNHL. The predictive prognostic model revealed that a high value of NLDA [odds ratio (OR), 4.363; 95% confidence interval (CI), 0.828–10.416; P < 0.05] and a low level of PNI (OR, 2.439; 95% CI, 1.188–5.006; P < 0.05) were independent risk factors for ineffective AF-SSNHL treatment. The concordance indexes for internal and external validation of the predictive model were 0.815 (95% CI, 0.754–0.875, P = 0.770) and 0.788 (95% CI, 0.663–0.913, P = 0.348), respectively. The areas under the curves of the nomogram-based predicted probabilities (nomogram scores) were 0.815 (95%CI, 0.754–0.875; P < 0.05) and 0.849 (95%CI, 0.737–0.961; P < 0.05), respectively. PNI and NLDA were superior hematological parameters and independent predictors of AF-SSNHL prognosis. Our predictive model, visualized as a nomogram based on vertigo, hearing level onset, PNI, and NLDA, may facilitate individualized prediction of treatment outcome of AF-SSNHL.

Trial registration: ChiCTR1800017072, https://www.chictr.org.cn/showprojen.aspx?proj=29023, Registration Date: 07/10/2018.

Data availability

The data used to support the findings of this study are available from the corresponding author on reasonable request.

Abbreviations

SSNHL:

Sudden sensorineural hearing loss

AF-SSNHL:

All-frequencies sudden sensorineural hearing loss

MRI:

Magnetic resonance imaging

PTA:

Pure tone average

BMI:

Body mass index

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

WBC:

White blood cell

N:

Neutrophil

L:

Lymphocyte

PLT:

Platelet

D:

D-dimer

Fg:

Fibrinogen

RBC:

Red blood cell

Hb:

Hemoglobin

ALB:

Albumin

NLR:

Neutrophil-to-lymphocyte ratio

PLR:

Platelet-to-lymphocyte ratio

SII:

Systemic immune inflammation index

PNI:

Prognostic nutritional index

NLDA:

Neutrophil lymphocyte D-dimer albumin score

NLFgA:

Neutrophil lymphocyte fibrinogen albumin score

AUC:

Area under the curve

ROC:

Receiver operating characteristic

OR:

Odds ratio

CI:

Confidence interval

DCA:

Decision curve analysis

C-index:

Concordance index

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Acknowledgements

We thank the participants of this study.

Funding

This study was supported by grants-in-aid from the National Natural Science Foundation of China (No. 82371152 and No. 82171139) and the Joint research project of Pudong New Area Municipal Health Commission PW2020D-9.

Author information

Author notes

  1. These authors contributed equally: Zhong Zheng, Liang Xia and Xiaoyan Chen.

Authors and Affiliations

  1. Department of Otolaryngology–Head and Neck Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zhong Zheng, Liang Xia, Xiaoyan Chen, Yi Chen, Kexin Song, Lili Xiao, Niannian Li & Yanmei Feng

  2. Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China

    Zhong Zheng, Liang Xia, Xiaoyan Chen, Yi Chen, Kexin Song, Lili Xiao, Niannian Li & Yanmei Feng

  3. Department of Otolaryngology, Xijing Hospital, The Air Force Military Medical University, Xi’an, Shaanxi, China

    Zhong Zheng & Fuquan Chen

  4. Department of Ophthalmology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Hui Li

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Contributions

Conceptualization: Zhong Zheng, Liang Xia, Xiaoyan Chen, Yanmei Feng; methodology: Fuquan Chen, and Yanmei Feng; software: Yi chen and Niannian Li; validation: Zhong Zheng and Xiaoyan Chen; formal analysis: Hui Li and Lili Xiao; investigation: Zhong Zheng, Xiaoyan Chen, Kexin Song, Niannian Li, and Lili Xiao; data curation: Yanmei Feng; original draft preparation: Zhong Zheng, Hui Li, review and editing: Fuquan Chen and Yanmei Feng.

Corresponding authors

Correspondence to Fuquan Chen, Hui Li or Yanmei Feng.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study protocol was approved and implemented according to the ethical standards of the Shanghai Jiaotong University Affiliated Sixth People’s s Hospital ethics committee. Information of patients was anonymized and de-identified before analysis. The progress was conducted in accordance with the spirit of the Helsinki Declaration. All participants provided written informed consent for their inclusion in the database and the use of their data for research purposes.

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Zheng, Z., Xia, L., Chen, X. et al. A prognostic nomogram for all frequencies sudden sensorineural hearing loss based on the commixed index of inflammatory–immune–hemostasis–nutrition. Sci Rep (2026). https://doi.org/10.1038/s41598-026-46821-2

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  • Received: 16 December 2024

  • Accepted: 27 March 2026

  • Published: 01 April 2026

  • DOI: https://doi.org/10.1038/s41598-026-46821-2

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Keywords

  • All frequencies sudden sensorineural hearing loss
  • Inflammatory–immune–hemostasis–nutrition index
  • Nomogram
  • Prognosis
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