Development and Clinical Translation of a Perioperative Nomogram Incorporating Free Fatty Acids to Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment

Abstract

Objective: A reliable prediction of clinical outcome is important for clinicians to set appropriate medical strategies in treating patients with aneurysmal subarachnoid hemorrhage (aSAH). In this study, we aim to establish a perioperative nomogram involving serum lipid signatures for predicting poor outcomes at 3 months in patients with aSAH following endovascular therapy.Methods: Data of patients with aSAH receiving endovascular therapy were collected. Univariable and multivariable analyses were performed to screen independent predictors related to unfavorable outcomes defined by the modified Rankin Scale (mFS) ≥3. A novel nomogram based on these significant features was conducted. The clinical application of this nomogram was assessed by decision curve analysis (DCA) and clinical impact curve.Results: A total number of patients included in this study were 213 (average age 58.9 years, 65.7% female), representing a poor 3-month outcome rate of 48.8%. Free fatty acid (FFA) levels on admission were efficient in predicting poor outcomes compared with other contents in serum lipids. Univariable and multivariable analyses revealed advanced age (P = 0.034), poor Hunt Hess (HH) (odds ratio, OR = 3.7, P < 0.001) and mFS (OR = 6.0, P < 0.001), aneurysms in the posterior circulation (OR = 4.4, P = 0.019), and higher FFA levels on admission (OR = 3.1, P = 0.021) were negative independent predictors of poor 3 months outcome. A novel nomogram composed of these significant features presented a concordance index (C-index) of 0.831 while the practical benefit was validated by DCA and clinical impact curve. An online calculator based on R programming promoted the clinical application of this nomogram.Conclusion: Nomogram involving age, HH grade, mFS, aneurysm location, and serum FFA levels was sufficient to provide an individualized prediction of 3-month poor outcome for each patient with aSAH who underwent endovascular therapy.

A novel visual dynamic nomogram to online predict the risk of unfavorable outcome in elderly aSAH patients after endovascular coiling: A retrospective study

“…To our knowledge, four nomograms were developed and the performance of the nomograms yielded AUCs ranging from 0.784 to 0.885 ( Zhang et al, 2020 ; Hu et al, 2021 ; Wang et al, 2021 ; Yan et al, 2021 ). Two nomograms reached an AUC of 0.831 and 0.851 for incorporating free fatty acids and SIRI, respectively ( Zhang et al, 2020 ; Wang et al, 2021 ). Apart from these, reached an AUC of 0.784 for a traditional nomogram with 9 variables ( Yan et al, 2021 ).…”

“…Studies have shown that endovascular coiling, as a major tool for managing aSAH ( Connolly et al, 2012 ), is associated with a better outcome compared with neurosurgical clipping ( Molyneux et al, 2005 , 2015 ; Lindgren et al, 2018 ; Belavadi et al, 2021 ). However, endovascular coiling still carries an approximately 18–48.8% risk of unfavorable outcome ( Molyneux et al, 2005 , 2015 ; Duan et al, 2016 ; Lindgren et al, 2018 ; Wang et al, 2021 ). And increasing age was associated with increased risk of death and unfavorable outcome ( Inagawa et al, 1988 ; Ohkuma et al, 2017 ; Øie et al, 2020 ).…”

“…In our investigation for prediction nomograms of aSAH outcome, four prediction models were developed in whole aSAH patients, but not in elderly aSAH patients. The performance of these prediction nomograms yielded AUCs ranging from 0.784 to 0.885 ( Zhang et al, 2020 ; Hu et al, 2021 ; Wang et al, 2021 ; Yan et al, 2021 ). These previous studies, although not predicting elderly patients, have proven the efficacy and potential of nomogram approaches in aSAH medical fields.…”

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

“…Nomograms have been studied in the field of aSAH; however, there are few studies on poor-grade aSAH ( 39 – 41 ). To the best of our knowledge, no nomogram studies have been performed on patients with poor-grade aneurysms who underwent surgical clipping.…”

Prediction and prognosis of delayed cerebral ischemia via continuous monitoring of blood-brain barrier permeability

“…In addition to clarifying the role of admission and DCITW K trans , our findings are also in line with previous studies suggesting that age, SEBES, and mFS are independent predictors of DCI, 30,31 while age, H-H, and mFS are independent predictors of poor outcome. 11,32 All the predictors mentioned above can be quickly obtained in a short period of time, allowing for a simple and feasible prediction model when combined with K trans at admission or during DCITW.…”