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

Frontiers in Neurology

Neurology

Chunlei Zhang¹  Zhaopeng Zhou¹  Hongqiao Yang¹  Zhuanghua Liu¹  Chenxu Zhang¹  Junhui Chen²  Yuhai Wang² 

[1] Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, China;null;

关键词: subarachnoid hemorrhage (SAH);    aneurysm;    poor-grade;    outcome;    nomogram;   

DOI  :  10.3389/fneur.2023.1146106

 received in 2023-01-17, accepted in 2023-03-06,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveAneurysmal subarachnoid hemorrhage (aSAH) is a common and potentially fatal cerebrovascular disease. Poor-grade aSAH (Hunt-Hess grades IV and V) accounts for 20–30% of patients with aSAH, with most patients having a poor prognosis. This study aimed to develop a stable nomogram model for predicting adverse outcomes at 6 months in patients with aSAH, and thus, aid in improving the prognosis.MethodThe clinical data and imaging findings of 150 patients with poor-grade aSAH treated with microsurgical clipping of intracranial aneurysms on admission from December 2015 to October 2021 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO), logistic regression analyses, and a nomogram were used to develop the prognostic models. Receiver operating characteristic (ROC) curves and Hosmer–Lemeshow tests were used to assess discrimination and calibration. The bootstrap method (1,000 repetitions) was used for internal validation. Decision curve analysis (DCA) was performed to evaluate the clinical validity of the nomogram model.ResultLASSO regression analysis showed that age, Hunt-Hess grade, Glasgow Coma Scale (GCS), aneurysm size, and refractory hyperpyrexia were potential predictors for poor-grade aSAH. Logistic regression analyses revealed that age (OR: 1.107, 95% CI: 1.056–1.116, P < 0.001), Hunt-Hess grade (OR: 8.832, 95% CI: 2.312–33.736, P = 0.001), aneurysm size (OR: 6.871, 95% CI: 1.907–24.754, P = 0.003) and refractory fever (OR: 3.610, 95% CI: 1.301–10.018, P < 0.001) were independent predictors of poor outcome. The area under the ROC curve (AUC) was 0.909. The calibration curve and Hosmer–Lemeshow tests showed that the nomogram had good calibration ability. Furthermore, the DCA curve showed better clinical utilization of the nomogram.ConclusionThis study provides a reliable and valuable nomogram that can accurately predict the risk of poor prognosis in patients with poor-grade aSAH after microsurgical clipping. This tool is easy to use and can help physicians make appropriate clinical decisions to significantly improve patient prognosis.

【 授权许可】

Unknown   
Copyright © 2023 Zhou, Liu, Yang, Zhang, Zhang, Chen and Wang.