Zhang Yang, Yan Chunxiang, Lu Guangyu, Diao Haiqing, Liu Xiaoguang, Ma Qiang, Yu Hailong, Yang Lin, Li Yuping
Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China.
Neurosurg Rev. 2025 Feb 10;48(1):228. doi: 10.1007/s10143-025-03346-y.
Despite extensive research on prediction models for outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients, the distinction between models for short- and long-term outcomes remains insufficiently explored. This study aims to compare these models, identify the risk factors of poor outcomes, summarize the predictors of outcomes, and assess the performance of the prediction models for short- and long-term outcomes in aSAH patients. PubMed, Web of Science, the Cochrane Library, and Embase were searched to identify studies investigating risk factors for developed and/or validated prediction models for short-term (< 12 months) and long-term (≥ 12 months) outcomes in aSAH patients. The main outcome was neurological function, defined as poor if the Glasgow Outcome Scale (GOS) score was ≤ 3, or if the modified Rankin Scale (mRS) score was ≥ 3. Fifty-six studies reporting 61 models with 36,879 aSAH patients were included. A total of 93 predictors were examined and categorized into six domains including demographic factors, scoring systems, clinical factors, aneurysm characteristics, laboratory examinations, and imaging features. Among these, laboratory examinations were included in 57.45% (27/47) of models predicting short-term outcomes, while only 14.29% (2/14) of long-term prediction models incorporated them. An mFisher score of 3-4 [OR = 1.95, 95%CI (1.43, 2.64), P < 0.01] and the presence of multiple aneurysms [OR = 1.56, 95% CI (1.25, 1.94), P < 0.01] were identified as risk factors for poor short-term outcomes, however, this association was weakened in predicting poor long-term outcomes. All studies were found to have a high risk of bias, primarily due to inappropriate data sources and inadequate reporting of the analysis domain. This review suggested that aSAH patients with poor clinical scores and hypertension are at a higher risk of poor outcomes. The majority of the included prediction models perform well, but generally lack reporting in the analysis domain, which may hinder their clinical applicability.
尽管对动脉瘤性蛛网膜下腔出血（aSAH）患者预后的预测模型进行了广泛研究，但针对短期和长期预后模型之间的差异仍未得到充分探讨。本研究旨在比较这些模型，确定不良预后的危险因素，总结预后的预测因素，并评估aSAH患者短期和长期预后预测模型的性能。检索了PubMed、科学网、考克兰图书馆和Embase，以确定调查aSAH患者短期（<12个月）和长期（≥12个月）预后的已开发和/或验证的预测模型的危险因素的研究。主要结局为神经功能，如果格拉斯哥预后量表（GOS）评分≤3或改良Rankin量表（mRS）评分≥3，则定义为不良。纳入了56项研究，报告了61个模型，涉及36879例aSAH患者。共检查了93个预测因素，并将其分为六个领域，包括人口统计学因素、评分系统、临床因素、动脉瘤特征、实验室检查和影像学特征。其中，实验室检查包含在57.45%（27/47）的短期预后预测模型中，而长期预测模型中只有14.29%（2/14）纳入了实验室检查。mFisher评分为3 - 4[比值比（OR）=1.9
5，95%置信区间（CI）（1.43，2.64），P<0.01]和存在多个动脉瘤[OR=1.56，95%CI（1.25，1.94），P<0.01]被确定为短期不良预后的危险因素，然而，在预测长期不良预后时这种关联减弱。所有研究均被发现存在高偏倚风险，主要原因是数据来源不当以及分析领域报告不充分。本综述表明，临床评分差和患有高血压的aSAH患者预后不良的风险更高。大多数纳入的预测模型表现良好，但在分析领域普遍缺乏报告，这可能会阻碍其临床应用。
