Abstract：
OBJECTIVE: This study aimed to identify predictors of rapid improvement of papilledema after stenting and develop a simple preintervention scale.
METHODS: A prospective cohort of idiopathic intracranial hypertension (IIH) with venous sinus stenosis (VSS) treated with stenting in a tertiary hospital from January 2014 to December 2019 was reviewed. We categorized papilledema improvement into favorable (grades 0-1) and unfavorable (grades 2-5). We employed logistic regression analysis to find the predictive factors and develop the predictive scale. We then estimated the performance of the scale using the ROC curve and Hosmer-Lemeshow test.
RESULTS: There were 110 patients who underwent venous sinus stenting, with a mean age of 37.1 years and a predominance of females (77.3%). A total of 85 patients had a favorable outcome following stenting, while 25 patients had an unfavorable outcome. The results of the multivariate analysis indicate that lower preoperative pressure gradients (odds ratio, OR: 4.01; 95% confidence interval, CI: 1.27-12.68), stenosis rates (OR: 4.16; 95% CI: 1.11-15.56), and preoperative papilledema grades (OR: 2.92; 95% CI: 1.44-5.91) were independently associated with rapid improvement of papilledema following stenting treatment. The 3‑item scale exhibited good discrimination with an area under the curve (AOC) of 0.81 (95% CI 0.72-0.89, p < 0.001), as well as acceptable calibration determined by the Hosmer-Lemeshow test (P = 0.42). The optimal cut-off value of the scale (range 0-6 points) was ≥ 4 points, with a sensitivity of 72%, specificity of 73%, and accuracy of 78%.
CONCLUSIONS: The presence of lower preoperative pressure gradients, stenosis severity, and preoperative status of papilledema were identified as positive predictors of rapid improvement of the papilledema following stenting in IIH patients. The 3‑item scale provides a promising preintervention predictive model for predicting rapid response following stenting treatment in IIH patients with VSS.
METHODS: A prospective cohort of idiopathic intracranial hypertension (IIH) with venous sinus stenosis (VSS) treated with stenting in a tertiary hospital from January 2014 to December 2019 was reviewed. We categorized papilledema improvement into favorable (grades 0-1) and unfavorable (grades 2-5). We employed logistic regression analysis to find the predictive factors and develop the predictive scale. We then estimated the performance of the scale using the ROC curve and Hosmer-Lemeshow test.
RESULTS: There were 110 patients who underwent venous sinus stenting, with a mean age of 37.1 years and a predominance of females (77.3%). A total of 85 patients had a favorable outcome following stenting, while 25 patients had an unfavorable outcome. The results of the multivariate analysis indicate that lower preoperative pressure gradients (odds ratio, OR: 4.01; 95% confidence interval, CI: 1.27-12.68), stenosis rates (OR: 4.16; 95% CI: 1.11-15.56), and preoperative papilledema grades (OR: 2.92; 95% CI: 1.44-5.91) were independently associated with rapid improvement of papilledema following stenting treatment. The 3‑item scale exhibited good discrimination with an area under the curve (AOC) of 0.81 (95% CI 0.72-0.89, p < 0.001), as well as acceptable calibration determined by the Hosmer-Lemeshow test (P = 0.42). The optimal cut-off value of the scale (range 0-6 points) was ≥ 4 points, with a sensitivity of 72%, specificity of 73%, and accuracy of 78%.
CONCLUSIONS: The presence of lower preoperative pressure gradients, stenosis severity, and preoperative status of papilledema were identified as positive predictors of rapid improvement of the papilledema following stenting in IIH patients. The 3‑item scale provides a promising preintervention predictive model for predicting rapid response following stenting treatment in IIH patients with VSS.
摘要：
目的：本研究旨在确定支架置入后乳头水肿快速改善的预测因素，并制定简单的干预前量表。
方法：回顾性分析了2014年1月至2019年12月在三级医院接受支架置入治疗的特发性颅内高压（IIH）伴静脉窦狭窄（VSS）的前瞻性队列。我们将乳头水肿的改善分为有利的（0-1级）和不利的（2-5级）。我们采用logistic回归分析寻找预测因素并编制预测量表。然后，我们使用ROC曲线和Hosmer-Lemeshow检验来估计量表的性能。
结果：有110例患者接受了静脉窦支架置入术，平均年龄为37.1岁，女性占主导地位（77.3％）。共有85名患者在支架置入后获得了良好的结果，而25例患者有不利的结果。多变量分析的结果表明，术前压力梯度较低(比值比，OR：4.01；95%置信区间，CI:1.27-12.68),狭窄率（OR：4.16；95%CI：1.11-15.56），术前乳头水肿分级(OR:2.92;95%CI:1.44-5.91)与支架治疗后乳头水肿的快速改善独立相关。3项量表表现出良好的区分度，曲线下面积(AOC)为0.81(95%CI0.72-0.89，p<0.001)，以及通过Hosmer-Lemeshow试验确定的可接受校准（P=0.42）。量表的最佳截止值（范围0-6分）≥4分，灵敏度为72%,特异性为73%，准确率为78%。
结论：存在较低的术前压力梯度，狭窄严重程度,和术前乳头水肿状态被确定为IIH患者支架置入后乳头水肿快速改善的阳性预测因子。3项量表提供了一个有前途的干预前预测模型，用于预测患有VSS的IIH患者支架治疗后的快速反应。
方法：回顾性分析了2014年1月至2019年12月在三级医院接受支架置入治疗的特发性颅内高压（IIH）伴静脉窦狭窄（VSS）的前瞻性队列。我们将乳头水肿的改善分为有利的（0-1级）和不利的（2-5级）。我们采用logistic回归分析寻找预测因素并编制预测量表。然后，我们使用ROC曲线和Hosmer-Lemeshow检验来估计量表的性能。
结果：有110例患者接受了静脉窦支架置入术，平均年龄为37.1岁，女性占主导地位（77.3％）。共有85名患者在支架置入后获得了良好的结果，而25例患者有不利的结果。多变量分析的结果表明，术前压力梯度较低(比值比，OR：4.01；95%置信区间，CI:1.27-12.68),狭窄率（OR：4.16；95%CI：1.11-15.56），术前乳头水肿分级(OR:2.92;95%CI:1.44-5.91)与支架治疗后乳头水肿的快速改善独立相关。3项量表表现出良好的区分度，曲线下面积(AOC)为0.81(95%CI0.72-0.89，p<0.001)，以及通过Hosmer-Lemeshow试验确定的可接受校准（P=0.42）。量表的最佳截止值（范围0-6分）≥4分，灵敏度为72%,特异性为73%，准确率为78%。
结论：存在较低的术前压力梯度，狭窄严重程度,和术前乳头水肿状态被确定为IIH患者支架置入后乳头水肿快速改善的阳性预测因子。3项量表提供了一个有前途的干预前预测模型，用于预测患有VSS的IIH患者支架治疗后的快速反应。
