Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage

Abstract

The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT.The aim of this study was to develop and validate a predictive score for 1-year outcomes in individual elderly patients with aSAH underwent EVT.In this 10-year prospective study, 520 consecutive aSAH elderly (age ≥ 60 years) patients underwent EVT in a single center were included. The risk factors, periprocedural, and 1-year follow-up data of all patients were entered in a specific prospective database.The modified Rankin scale was used for evaluating clinical outcome. To optimize the model's predictive capacity, the original matrix was randomly divided in 2 submatrices (learning and testing). The predictive score was developed using Arabic numerals for all variables based on the variable coefficients (β) of multivariable logistic regression analysis in the learning set and the predictive performance evaluation was assessed in the testing set. The risk classes were constructed using classification criteria based on sensitivity and specificity.The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, Hunt–Hess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. The discriminative power analysis with the area under the receiver operating characteristic curve (AUC) of the Changhai score was statistically significant (0.864, 0.824–0.904, P < 0.001). The sensitivity and specificity of the Changhai score were 82.07% and 78.06%, respectively.Our study indicated that age, hypertension, Hunt–Hess scale, Fisher scale, aneurysm location, and periprocedural complications were independent risk factors of poor outcome for elderly aSAH patients underwent EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application.

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

“…These characterizations were consistent with previous studies aiming to predict adverse outcomes following aSAH treatment (25,26). For endovascular therapy, a grading system named Changhai score worked well on the aSAH clinical outcome prediction (21), of which the 4 pronounced risk factors including age, HH grade, mFS, and aneurysm location were identical to these findings. Although the HH grade and mFS have been widely used to evaluate the severity and outcome of aSAH in clinical practice, these evaluation scales have many limitations which could lead to the initial misdiagnosis due to the subjectivity of the neuro interventionalists or the adjudicated information (27,28).…”

Increased blood pressure variability predicts poor outcomes from endovascular treatment for aneurysmal subarachnoid hemorrhage

“…Consistently with these previous data, our study found that Hunt-Hess grade 3-4 was an independent risk factor for poor outcomes from ruptured cerebral aneurysms treated with endovascular embolization. In addition, higher Fisher grades have also been associated with severe cerebral vasospasm and poor treatment outcomes for aSAH 11,13 . We confirmed this in our study, through showing that Fisher grade 3-4 was an independent risk factor for poor treatment outcomes for aSAH.…”

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial

“…5,13 The Changhai score, developed in 2016, relied on age, hypertension, Hunt and Hess grade, Fisher grade, aneurysm location, and periprocedural complications with an area under the curve (AUC) of 0.864 (p < 0.001) but was not externally validated on completion. 14 Additionally, the Subarachnoid Hemorrhage International Trialists score was both internally and externally validated, but it had a smaller AUC (0.81) than the Changhai score and was not as useful for bedside grading. 9,11,15 The present study aimed to assess the validity of the SAFIRE grading scale for aSAH prognosis on long-term patient outcomes using BRAT data.…”