PDF(Pubmed)
Abstract：
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) causes long-term functional dependence and death. Early prediction of functional outcomes in aSAH patients with appropriate intervention strategies could lower the risk of poor prognosis. Therefore, we aimed to develop pre- and post-operative dynamic visualization nomograms to predict the 1-year functional outcomes of aSAH patients undergoing coil embolization.
METHODS: Data were obtained from 400 aSAH patients undergoing endovascular coiling admitted to the People\'s Hospital of Hunan Province in China (2015-2019). The key indicator was the modified Rankin Score (mRS), with 3-6 representing poor functional outcomes. Multivariate logistic regression (MLR)-based visual nomograms were developed to analyze baseline characteristics and post-operative complications. The evaluation of nomogram performance included discrimination (measured by C statistic), calibration (measured by the Hosmer-Lemeshow test and calibration curves), and clinical usefulness (measured by decision curve analysis).
RESULTS: Fifty-nine aSAH patients (14.8%) had poor outcomes. Both nomograms showed good discrimination, and the post-operative nomogram demonstrated superior discrimination to the pre-operative nomogram with a C statistic of 0.895 (95% CI: 0.844-0.945) vs. 0.801 (95% CI: 0.733-0.870). Each was well calibrated with a Hosmer-Lemeshow p-value of 0.498 vs. 0.276. Moreover, decision curve analysis showed that both nomograms were clinically useful, and the post-operative nomogram generated more net benefit than the pre-operative nomogram. Web-based online calculators have been developed to greatly improve the efficiency of clinical applications.
CONCLUSIONS: Pre- and post-operative dynamic nomograms could support pre-operative treatment decisions and post-operative management in aSAH patients, respectively. Moreover, this study indicates that integrating post-operative variables into the nomogram enhanced prediction accuracy for the poor outcome of aSAH patients.
METHODS: Data were obtained from 400 aSAH patients undergoing endovascular coiling admitted to the People\'s Hospital of Hunan Province in China (2015-2019). The key indicator was the modified Rankin Score (mRS), with 3-6 representing poor functional outcomes. Multivariate logistic regression (MLR)-based visual nomograms were developed to analyze baseline characteristics and post-operative complications. The evaluation of nomogram performance included discrimination (measured by C statistic), calibration (measured by the Hosmer-Lemeshow test and calibration curves), and clinical usefulness (measured by decision curve analysis).
RESULTS: Fifty-nine aSAH patients (14.8%) had poor outcomes. Both nomograms showed good discrimination, and the post-operative nomogram demonstrated superior discrimination to the pre-operative nomogram with a C statistic of 0.895 (95% CI: 0.844-0.945) vs. 0.801 (95% CI: 0.733-0.870). Each was well calibrated with a Hosmer-Lemeshow p-value of 0.498 vs. 0.276. Moreover, decision curve analysis showed that both nomograms were clinically useful, and the post-operative nomogram generated more net benefit than the pre-operative nomogram. Web-based online calculators have been developed to greatly improve the efficiency of clinical applications.
CONCLUSIONS: Pre- and post-operative dynamic nomograms could support pre-operative treatment decisions and post-operative management in aSAH patients, respectively. Moreover, this study indicates that integrating post-operative variables into the nomogram enhanced prediction accuracy for the poor outcome of aSAH patients.
摘要：
背景：动脉瘤性蛛网膜下腔出血（aSAH）导致长期的功能依赖和死亡。通过适当的干预策略，早期预测aSAH患者的功能结局可以降低不良预后的风险。因此,我们旨在建立术前和术后动态可视化列线图,以预测接受弹簧圈栓塞的aSAH患者的1年功能结局.
方法：数据来自中国湖南省人民医院（2015-2019）收治的400例接受血管内盘绕的aSAH患者。关键指标是修改后的兰金评分(mRS)，3-6代表较差的功能结果。建立了基于多变量逻辑回归（MLR）的视觉列线图，以分析基线特征和术后并发症。列线图性能的评估包括辨别(用C统计量衡量)，校准（通过Hosmer-Lemeshow测试和校准曲线测量），和临床有用性(通过决策曲线分析衡量)。
结果：59例aSAH患者（14.8%）的预后较差。两个列线图都显示出良好的区分度，术后列线图显示出优于术前列线图的区别，C统计量为0.895（95％CI：0.844-0.945）与0.801（95%CI：0.733-0.870）。每个都很好地校准了Hosmer-Lemeshowp值0.498与0.276.此外，决策曲线分析表明，这两个列线图在临床上都是有用的，术后列线图比术前列线图产生更多的净效益。已经开发了基于Web的在线计算器，以大大提高临床应用的效率。
结论：术前和术后动态列线图可以支持aSAH患者的术前治疗决策和术后管理，分别。此外，这项研究表明,将术后变量纳入列线图可提高aSAH患者不良结局的预测准确性.
方法：数据来自中国湖南省人民医院（2015-2019）收治的400例接受血管内盘绕的aSAH患者。关键指标是修改后的兰金评分(mRS)，3-6代表较差的功能结果。建立了基于多变量逻辑回归（MLR）的视觉列线图，以分析基线特征和术后并发症。列线图性能的评估包括辨别(用C统计量衡量)，校准（通过Hosmer-Lemeshow测试和校准曲线测量），和临床有用性(通过决策曲线分析衡量)。
结果：59例aSAH患者（14.8%）的预后较差。两个列线图都显示出良好的区分度，术后列线图显示出优于术前列线图的区别，C统计量为0.895（95％CI：0.844-0.945）与0.801（95%CI：0.733-0.870）。每个都很好地校准了Hosmer-Lemeshowp值0.498与0.276.此外，决策曲线分析表明，这两个列线图在临床上都是有用的，术后列线图比术前列线图产生更多的净效益。已经开发了基于Web的在线计算器，以大大提高临床应用的效率。
结论：术前和术后动态列线图可以支持aSAH患者的术前治疗决策和术后管理，分别。此外，这项研究表明,将术后变量纳入列线图可提高aSAH患者不良结局的预测准确性.
