Aim:Grade 4 diffuse gliomas is a highly malignant tumor with considerable health implications. Studies have investigated the immunohistochemical molecules associated with glioblastoma development. However, grade 4 diffuse gliomas in Ki-67 positive patients have not been conclusively investigated.Material and Methods:We retrospectively extracted data for 146 patients with Ki-67 positive grade 4 diffuse gliomas. The data were analyzed using the R software. Statistically significant indicators were identified by COX regression analysis and used to establish the nomogram. The nomogram was corrected by C-index, area under the curve (AUC), calibration curve and decision curve analyses (DCA). Finally, the model was externally validated using the Chinese Glioma Genome Atlas (CGGA) database.Results:Age, treatment and IDH were found to be significant. The models’ C-index was 0.743 while the area under the curve (AUC) value of the time-dependent ROC curve at 3- and 6-months were 0.832 and 0.829, respectively. These findings imply a good discriminatory ability. Finally, a nomogram was constructed and validated using validation and DCA curves. Conclusion:Three risk factors (age, treatment and IDH) were identified to be independent prognostic factors in Ki-67 positive grade 4 diffuse gliomas patients. The model can be used to accurately assess the disease-specific survival rates of these patients and inform on treatment options.