From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), University of Groningen, University Medical Center Groningen, the Netherlands.
Center for Statistics in Medicine, Oxford, United Kingdom (J.B.).
Stroke. 2019 Apr;50(4):837-844. doi: 10.1161/STROKEAHA.118.023902.
Background and Purpose- Early prediction of clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH) is still lacking accuracy. In this observational cohort study, we aimed to develop and validate an accurate bedside prediction model for clinical outcome after aSAH, to aid decision-making at an early stage. Methods- For the development of the prediction model, a prospectively kept single-center cohort of 1215 aSAH patients, admitted between 1998 and 2014, was used. For temporal validation, a prospective cohort of 224 consecutive aSAH patients from the same center, admitted between 2015 and 2017, was used. External validation was performed using the ISAT (International Subarachnoid Aneurysm Trial) database (2143 patients). Primary outcome measure was poor functional outcome 2 months after aSAH, defined as modified Rankin Scale score 4-6. The model was constructed using multivariate regression analyses. Performance of the model was examined in terms of discrimination and calibration. Results- The final model included 4 predictors independently associated with poor outcome after 2 months: age, World Federation of Neurosurgical Societies grade after resuscitation, aneurysm size, and Fisher grade. Temporal validation showed high discrimination (area under the receiver operating characteristic curve, 0.90; 95% CI, 0.85-0.94), external validation showed fair to good discrimination (area under the receiver operating characteristic curve, 0.73; 95% CI, 0.70-0.76). The model showed satisfactory calibration in both validation cohorts. The SAFIRE grading scale was derived from the final model: size of the aneurysm, age, Fisher grade, world federation of neurosurgical societies after resuscitation. Conclusions- The SAFIRE grading scale is an accurate, generalizable, and easily applicable model for early prediction of clinical outcome after aSAH.
背景与目的- 目前，对于动脉瘤性蛛网膜下腔出血（aSAH）后临床结局的早期预测仍缺乏准确性。在本项观察性队列研究中，我们旨在开发和验证一种用于预测 aSAH 后临床结局的准确床边预测模型，以帮助在早期做出决策。
方法- 为了开发预测模型，我们使用了 1998 年至 2014 年间在一家单中心前瞻性保留的 1215 例 aSAH 患者队列进行研究。为了进行时间验证，我们使用了来自同一中心的 2015 年至 2017 年间连续 224 例 aSAH 患者的前瞻性队列。使用 ISAT（国际蛛网膜下腔动脉瘤试验）数据库（2143 例患者）进行外部验证。主要结局测量指标为 aSAH 后 2 个月时的不良功能结局，定义为改良 Rankin 量表评分 4-6 分。该模型是通过多变量回归分析构建的。通过判别和校准来评估模型的性能。
结果- 最终模型包括 4 个与 2 个月后不良结局独立相关的预测因子：年龄、复苏后世界神经外科学会分级、动脉瘤大小和 Fisher 分级。时间验证显示出较高的判别能力（受试者工作特征曲线下面积，0.90；95%可信区间，0.85-0.94），外部验证显示出良好到中等的判别能力（受试者工作特征曲线下面积，0.73；95%可信区间，0.70-0.76）。该模型在两个验证队列中均显示出良好的校准度。SAFIRE 分级量表是从最终模型中衍生出来的：动脉瘤大小、年龄、Fisher 分级、复苏后世界神经外科学会分级。
结论- SAFIRE 分级量表是一种准确、可推广且易于应用的 aSAH 后临床结局早期预测模型。
