Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
World Neurosurg. 2023 Jul;175:e108-e114. doi: 10.1016/j.wneu.2023.03.036. Epub 2023 Mar 11.
Delayed cerebral ischemia (DCI) may significantly worsen the functional status of patients with aneurysmal subarachnoid hemorrhage (aSAH). Several authors have designed predictive models for early identification of patients at risk of post-aSAH DCI. In this study, we externally validate an extreme gradient boosting (EGB) forecasting model for post-aSAH DCI prediction.
A 9-year institutional retrospective review of patients with aSAH was performed. Patients were included if they underwent surgical or endovascular treatment and had available follow-up data. DCI was diagnosed as new-onset neurologic deficits at 4-12 days after aneurysm rupture, defined as worsening Glasgow Coma Scale score for ≥2 points, and new ischemic infarcts at imaging.
We collected 267 patients with aSAH. At admission, median Hunt-Hess score was 2 (range, 1-5), median Fisher score 3 (range, 1-4), and median modified Fisher score 3 (range, 1-4). One-hundred and forty-five patients underwent external ventricular drainage placement for hydrocephalus (54.3%). The ruptured aneurysms were treated with clipping (64%), coiling (34.8%), and stent-assisted coiling (1.1%). Fifty-eight patients (21.7%) were diagnosed with clinical DCI and 82 (30.7%) with asymptomatic imaging vasospasm. The EGB classifier correctly predicted 19 cases of DCI (7.1%) and 154 cases of no-DCI (57.7%), achieving sensitivity of 32.76% and specificity of 73.68%. The calculated F1 score and accuracy were 0.288% and 64.8%, respectively.
We validated that the EGB model is a potential assistant tool to predict post-aSAH DCI in clinical practice, finding moderate-high specificity but low sensitivity. Future research should investigate the underlying pathophysiology of DCI to allow the development of high-performing forecasting models.
迟发性脑缺血（DCI）可能显著恶化颅内动脉瘤性蛛网膜下腔出血（aSAH）患者的功能状态。已有几位作者设计了预测模型，以早期识别有发生 post-aSAH DCI 风险的患者。本研究我们对 post-aSAH DCI 预测的极端梯度提升（EGB）预测模型进行了外部验证。
对一家机构进行了一项为期 9 年的 aSAH 患者回顾性研究。如果患者接受了手术或血管内治疗且有随访数据，则将其纳入研究。DCI 的诊断标准为动脉瘤破裂后 4-12 天出现新发神经功能缺损，定义为格拉斯哥昏迷评分（GCS）恶化≥2 分和影像学上新出现的缺血性梗死。
共收集了 267 例 aSAH 患者。入院时，中位 Hunt-Hess 评分 2 分（范围，1-5 分），中位 Fisher 评分 3 分（范围，1-4 分），中位改良 Fisher 评分 3 分（范围，1-4 分）。145 例患者因脑积水行脑室外引流术（54.3%）。破裂的动脉瘤采用夹闭（64%）、弹簧圈（34.8%）和支架辅助弹簧圈（1.1%）治疗。58 例（21.7%）患者诊断为临床 DCI，82 例（30.7%）为无症状性影像学血管痉挛。EGB 分类器正确预测了 19 例 DCI（7.1%）和 154 例非 DCI（57.7%），其敏感性为 32.76%，特异性为 73.68%。计算得到的 F1 评分和准确性分别为 0.288%和 64.8%。
我们验证了 EGB 模型是预测临床实践中 post-aSAH DCI 的潜在辅助工具，发现其具有较高的特异性和较低的敏感性。未来的研究应深入探究 DCI 的潜在病理生理学，以开发高性能的预测模型。
