A nomogram for predicting the risk of poor prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage following microsurgical clipping

Zhou, Zhaopeng; Liu, Zhuanghua; Yang, Hongqiao; Zhang, Chunlei; Zhang, Chenxu; Chen, Junhui; Wang, Yuhai

doi:10.3389/fneur.2023.1146106

Cited by 4 publications

(2 citation statements)

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“…However, this model did not consider the severity of the disease on admission, which significantly affected the clinical outcomes. Another predictive model recently reported by Zhou et al has enrolled 150 patients with WFNS IV–V and established a nomogram with an accuracy of 0.909 ( 22 ). However, all patients analyzed in their study were treated by clipping, which may bias the results.…”

Section: Discussionmentioning

confidence: 99%

A nomogram for the prediction of short-term mortality in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a post-hoc analysis

Mei,

Shen,

Liu

2024

Front. Neurol.

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BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is a devastating stroke subtype with high morbidity and mortality. Although several studies have developed a prediction model in aSAH to predict individual outcomes, few have addressed short-term mortality in patients requiring mechanical ventilation. The study aimed to construct a user-friendly nomogram to provide a simple, precise, and personalized prediction of 30-day mortality in patients with aSAH requiring mechanical ventilation.MethodsWe conducted a post-hoc analysis based on a retrospective study in a French university hospital intensive care unit (ICU). All patients with aSAH requiring mechanical ventilation from January 2010 to December 2015 were included. Demographic and clinical variables were collected to develop a nomogram for predicting 30-day mortality. The least absolute shrinkage and selection operator (LASSO) regression method was performed to identify predictors, and multivariate logistic regression was used to establish a nomogram. The discriminative ability, calibration, and clinical practicability of the nomogram to predict short-term mortality were tested using the area under the curve (AUC), calibration plot, and decision curve analysis (DCA).ResultsAdmission GCS, SAPS II, rebleeding, early brain injury (EBI), and external ventricular drain (EVD) were significantly associated with 30-day mortality in patients with aSAH requiring mechanical ventilation. Model A incorporated four clinical factors available in the early stages of the aSAH: GCS, SAPS II, rebleeding, and EBI. Then, the prediction model B with the five predictors was developed and presented in a nomogram. The predictive nomogram yielded an AUC of 0.795 [95% CI, 0.731–0.858], and in the internal validation with bootstrapping, the AUC was 0.780. The predictive model was well-calibrated, and decision curve analysis further confirmed the clinical usefulness of the nomogram.ConclusionWe have developed two models and constructed a nomogram that included five clinical characteristics to predict 30-day mortality in patients with aSAH requiring mechanical ventilation, which may aid clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

A nomogram for the prediction of short-term mortality in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a post-hoc analysis

Mei,

Shen,

Liu

2024

Front. Neurol.

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“…Отже, вибір лікувальної тактики зазначеної ка т е г орі ї х в ор и х має бу т и ін д иві дуа льним з урахуванням багатьох чинників [18,19].…”

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Clinical and neuroimaging predictors of the outcome of microsurgical intervention against the background of cerebral aneurysms rupture

Kazantseva,

Zorin

2024

Ukr Neurosurg J

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Objective: minimization of the risks of complications of microsurgical intervention (MI) for cerebral aneurysm (CA) rupture due to established clinical and neuroimaging predictors. Material and methods. Evaluation of microsurgical treatment of 418 patients in the acute period of cerebral aneurysms (CA) rupture in the 2013-2018 period, that were operated at the Vascular Neurosurgery Center of the Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, taking into account factors that may have an influence on favorable or unfavorable functional consequences. Age, gender, as well as clinical-neurological and neuroimaging assessment of the condition of patients according to the severity of aneurysmal subarachnoid hemorrhage (SAH) according to the Hunt-Hess classification, WFNS, level of consciousness impairment according to the Glasgow Coma Scale (GCS) were studied. The severity of aneurysmal subarachnoid hemorrhage was evaluated according to the Fisher prognostic scale according to the performed spiral computed tomography (SCT). Cerebral angiospasm (CAS) was evaluated according to cerebral angiography (CAG), and its severity according to transcranial dopplerography (TCD) on the day of hospitalization and surgery. The performed microsurgical intervention (MI) was evaluated according to the Glasgow Outcome Scale (GOS). The study was both retrospective and prospective. Results. Among 77 (18.4%) patients with adverse consequences of MI according to 1-3 points of GOS, a dependence was reliably found on the level of consciousness disturbance according to GCS, the severity of meningeal and focal symptoms, the severity of parenchymal hemorrhage, CAS manifestations on the day of surgery according to TCD, the duration of surgery after the rupture of CA (p<0.001). There was no statistically significant relationship between age, sex, localization, form and side of CA rupture. Also, a strong inverse correlation was found between GCS and classification of SAH according to WFNS rs=‒0.96 (95% CI 0.96-0.97) and Hunt-Hess rs=‒0.81 (95% CI 0.77-0.84) during hospitalization. Conclusions. The effectiveness of MI in the case of CA rupture depends on the severity of prognostic criteria of clinical and neurological examination - evaluation by the GCS, neurological disorders, severity of parenchymal hemorrhage, manifestations of CAS on the day of surgery for TCD, the duration of surgery after CA rupture. Revealed relationship between the score according to the GOS, classifications of SAH according to the WFNS and Hunt-Hess significantly simplifies diagnostic measures during the examination of patients in the acute period of CA rupture.

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A nomogram model for predicting postoperative prognosis in patients with aneurysmal subarachnoid hemorrhage using preoperative biochemical indices

Sun,

Xue,

Wang

et al. 2024

BMC Neurol

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Objective The nutritional status and inflammatory responses of patients with aneurysmal subarachnoid hemorrhage (aSAH) play a vital prognostic role. We investigated the relationship between preoperative prognostic nutritional index (PNI)、neutrophil/albumin ratio (NAR)、platelet/albumin ratio (PAR) and other factors and the clinical prognosis of patients who underwent clipping for aSAH and its predictive model. Methods The clinical data of 212 patients with aSAH who underwent neurosurgery at Nanyang Central Hospital between 2018 and 2023 were retrospectively analyzed. Based on the Glasgow Outcome Scale (GOS) score at 6 months postoperatively, the patients were categorized into two groups: poor (GOSI-III) and good (GOSIV-V) prognosis groups. Multivariate logistic regression analysis was performed to determine the predictive value of preoperative PNI、NAR、PAR、hyperlipidemia and Glasgow Coma Scale (GCS) for prognosis. Furthermore, nomograms and prognostic prediction models were constructed. Receiver operating characteristic curves and area under the curve (AUC) were utilized to determine the predictive values. Results Multivariate logistic regression analysis revealed that PNI (OR = 1.250, 95%CI 1.060 ~ 1.475, P = 0.008), NAR (OR = 0.000, 95%CI 0.000 ~ 0.004, P = 0.000), PAR(OR = 0.515, 95%CI 0.283 ~ 0.937, P = 0.030), hyperlipidemia (OR = 4.627, 95%CI 1.166 ~ 18.367, P = 0.029), and GCS(OR = 1.446, 95%CI 1.041 ~ 2.008, P = 0.028) are independent risk factors for poor postoperative prognosis. The total score of the nomogram was 200, and the AUC value was 0.972. Conclusions PNI and NAR can reflect the nutritional status and inflammatory responses of patients.They are significantly associated with the postoperative prognosis of patients with aSAH. Comprehensively analyzing PNI and NAR combined with other clinical indicators can more effectively guide treatment and help predict prognosis.

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A nomogram for predicting the risk of poor prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage following microsurgical clipping

Cited by 4 publications

References 42 publications

A nomogram for the prediction of short-term mortality in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a post-hoc analysis

A nomogram for the prediction of short-term mortality in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a post-hoc analysis

Clinical and neuroimaging predictors of the outcome of microsurgical intervention against the background of cerebral aneurysms rupture

A nomogram model for predicting postoperative prognosis in patients with aneurysmal subarachnoid hemorrhage using preoperative biochemical indices

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