Abstract: Objective: By analyzing the relationship between clinical features and prognosis of adult tetanus patients, a nomogram model was established to predict the death risk of adult tetanus patients, and its accuracy and clinical efficacy were verified and evaluated.Methods: Ninety-seven cases of adult tetanus patients admitted to Nanjing Second Hospital from January 2013 to December 2019 were analyzed retrospectively. According to whether the patients survived, they were divided into survival group and death group. The demographic data of two groups of patients including gender, age, whether they are combined with underlying diseases, clinical manifestations including Ablett grade, latency, onset time, whether they are complicated with lung infection, treatment including wound debridement, use of tetanus antitoxin and tetanus human immunoglobulin, endotracheal intubation or incision and mechanical ventilation, sedation and analgesia, use of muscle relaxant and nutritional support. Single-factor and multi-factor regression analysis were performed on the included indicators to screen out independent risk factors for predicting the death risk of adult tetanus patients. The nomogram model was obtained by using R language software to visually process the logistic regression(LR) model, and the accuracy and clinical efficacy of the model were evaluated.Results: Multivariate logistic regression analysis showed that the use of tetanus human immunoglobulin(OR=0.201, 95%CI: 0.047-0.865), and whether the wound was debrided(OR=0.231, 95%CI: 0.058-0.926), whether mechanical ventilation(OR=12.57, 95%CI: 2.664-59.35) were the independent risk factors predicting the probability of death in adult tetanus patients(P<0.05). According to the above independent risk factors, the C-index for predicting the mortality risk of adult tetanus patients is 0.876. The bootstrap method is used to verify the model internally. The calibration curve shows that the average absolute error between the nomogram model's prediction of death risk and the actual risk of adult tetanus patients is 0.056, and the ROC curve shows that the area under the curve is 0.876(95%CI: 0.804-0.948), showing its good accuracy. Decision Curve Analysis(DCA) showed that the net return rate of the full model based on the three risk factors was significantly higher than that of the single factor model.Conclusion: Undebrided wounds, non-use of tetanus human immunoglobulin, and the need for mechanical ventilation are independent risk factors for the death of adult tetanus patients. The prediction model based on these risk factors can accurately predict the death risk of adult tetanus patients and can be used effectively in clinical practice, suggested that the early wound debridement and the use of tetanus human immunoglobulin may reduce the mortality of these patients.