1Department of Neurosurgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi.
2Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, Jiangxi.
J Neurosurg. 2024 Mar 29;141(2):343-354. doi: 10.3171/2024.1.JNS232280. Print 2024 Aug 1.
The relationships between immediate bleeding severity, postoperative complications, and long-term functional outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH) remain uncertain. Here, the authors apply their recently developed automated deep learning technique to quantify total bleeding volume (TBV) in patients with aSAH and investigate associations between quantitative TBV and secondary complications, adverse long-term functional outcomes, and death.
Electronic health record data were extracted for adult patients admitted to a single institution within 72 hours of aSAH onset between 2018 and 2021. An automatic deep learning model was used to fully segment and quantify TBV on admission noncontrast head CT images. Patients were subgrouped by TBV quartile, and multivariable logistic regression, restricted cubic splines, and subgroup analysis were used to explore the relationships between TBV and each clinical outcome.
A total of 819 patients were included in the study. Sixty-six (8.1%) patients developed hydrocephalus, while 43 (5.3%) experienced rebleeding, 141 (17.2%) had delayed cerebral ischemia, 88 (10.7%) died in the 12 months after discharge, and 208 (25.7%) had a modified Rankin Scale score ≥ 3 12 months after discharge. On multivariable analysis, patients in the highest TBV quartile (> 37.94 ml) had an increased risk of hydrocephalus (adjusted OR [aOR] 4.38, 95% CI 1.61-11.87; p = 0.004), rebleeding (aOR 3.26, 95% CI 1.03-10.33; p = 0.045), death (aOR 6.92, 95% CI 1.89-25.37; p = 0.004), and 12-month disability (aOR 3.30, 95% CI 1.62-6.72; p = 0.001) compared with the lowest TBV quantile (< 8.34 ml). The risks of hydrocephalus (nonlinear, p = 0.025), rebleeding, death, and disability (linear, p > 0.05) were positively associated with TBV by restricted cubic splines. In subgroup analysis, TBV had a stronger effect on 12-month outcome in female than male patients (p for interaction = 0.0499) and on rebleeding prevalence in patients with endovascular coiling than those with surgical clipping (p for interaction = 0.008).
Elevated TBV is associated with a greater risk of hydrocephalus, rebleeding, death, and poor prognosis.
急性蛛网膜下腔出血（aSAH）患者的即刻出血严重程度、术后并发症与长期功能结局之间的关系尚不清楚。在此，作者应用其新开发的自动化深度学习技术来量化 aSAH 患者的总出血量（TBV），并探讨定量 TBV 与继发性并发症、不良长期功能结局和死亡之间的关联。
提取 2018 年至 2021 年间在 aSAH 发病后 72 小时内入住单一机构的成年患者的电子病历数据。使用自动深度学习模型对入院时的非对比头部 CT 图像进行全容积分割和 TBV 定量。根据 TBV 四分位数将患者分组，采用多变量逻辑回归、限制性立方样条和亚组分析来探讨 TBV 与每种临床结局之间的关系。
共纳入 819 例患者。66 例（8.1%）患者发生脑积水，43 例（5.3%）发生再出血，141 例（17.2%）发生迟发性脑缺血，88 例（10.7%）在出院后 12 个月内死亡，208 例（25.7%）在出院后 12 个月时改良 Rankin 量表评分≥3 分。多变量分析显示，TBV 最高四分位数（>37.94ml）的患者发生脑积水的风险增加（调整后的比值比[aOR] 4.38，95%CI 1.61-11.87；p=0.004）、再出血（aOR 3.26，95%CI 1.03-10.33；p=0.045）、死亡（aOR 6.92，95%CI 1.89-25.37；p=0.004）和 12 个月残疾（aOR 3.30，95%CI 1.62-6.72；p=0.001）的风险均高于 TBV 最低四分位数（<8.34ml）。脑积水（非线性，p=0.025）、再出血、死亡和残疾（线性，p>0.05）与 TBV 呈正相关，采用限制性立方样条分析。在亚组分析中，TBV 对女性患者的 12 个月结局（p 交互=0.0499）和血管内夹闭患者的再出血发生率（p 交互=0.008）的影响强于男性患者。
升高的 TBV 与脑积水、再出血、死亡和预后不良的风险增加相关。
