Chu Liang, Cao Kan, Jiang Kuan, Lu Yunpeng, Qi Ming, Wu Da
The Affiliated Yixing Hospital of Jiangsu University, Yixing, China.
The Affiliated Zhenjiang First Hospital of Jiangsu University, Zhenjiang, China.
Front Neurol. 2025 May 7;16:1466188. doi: 10.3389/fneur.2025.1466188. eCollection 2025.
This study aimed to evaluate early functional outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated with either endovascular coiling or surgical clipping and to develop predictive models tailored to each treatment modality.
Patients diagnosed with aSAH were retrospectively enrolled from two hospitals in China between January 1, 2015, and December 31, 2022. Based on the treatment approach, patients were divided into two groups: endovascular coiling and surgical clipping. Independent risk factors were identified using least absolute shrinkage and selection operator (LASSO) regression followed by multivariate logistic regression. The relative contribution of each significant factor was calculated, and nomograms were constructed accordingly. Model performance was subsequently assessed through validation analyses.
Multivariate analysis identified Hunt-Hess grade, Glasgow Coma Scale (GCS) score, modified Fisher Scale (mFS), D-dimer, age, and body temperature as independent predictors of early functional outcomes following endovascular coiling (all -values <0.05). For surgical clipping, Hunt-Hess grade, GCS score, mFS, and D-dimer emerged as significant predictors (all -values <0.05). The calculated relative contributions for endovascular coiling were 32.78% (Hunt-Hess grade), 31.99% (mFS), 4.63% (GCS score), and 13.73% (D-dimer); for surgical clipping, these values were 33.55, 38.02, 8.44, and 19.99%, respectively. Nomograms were developed for both treatment groups, and their performance was validated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA), demonstrating strong discriminative ability and clinical applicability.
This study developed predictive nomogram models for early functional outcomes of aSAH patients undergoing endovascular coiling or surgical clipping treatments, emphasizing the importance of scoring systems and clinical parameters (such as D-dimer), demonstrating strong clinical utility.
本研究旨在评估接受血管内栓塞或外科夹闭治疗的动脉瘤性蛛网膜下腔出血（aSAH）患者的早期功能结局，并建立针对每种治疗方式的预测模型。
回顾性纳入2015年1月1日至2022年12月31日期间在中国两家医院诊断为aSAH的患者。根据治疗方法，将患者分为两组：血管内栓塞组和外科夹闭组。使用最小绝对收缩和选择算子（LASSO）回归，随后进行多因素逻辑回归来确定独立危险因素。计算每个显著因素的相对贡献，并据此构建列线图。随后通过验证分析评估模型性能。
多因素分析确定，Hunt-Hess分级、格拉斯哥昏迷量表（GCS）评分、改良Fisher量表（mFS）、D-二聚体、年龄和体温是血管内栓塞术后早期功能结局的独立预测因素（所有P值<0.05）。对于外科夹闭，Hunt-Hess分级、GCS评分、mFS和D-二聚体是显著的预测因素（所有P值<0.05）。血管内栓塞的计算相对贡献分别为32.78%（Hunt-Hess分级）、31.99%（mFS）、4.63%（GCS评分）和13.73%（D-二聚体）；对于外科夹闭，这些值分别为33.55%、38.02%、8.44%和19.99%。为两个治疗组都建立了列线图，并使用受试者操作特征（ROC）曲线、校准图和决策曲线分析（DCA）对其性能进行了验证，显示出很强的判别能力和临床适用性。
本研究为接受血管内栓塞或外科夹闭治疗的aSAH患者的早期功能结局建立了预测列线图模型，强调了评分系统和临床参数（如D-二聚体）的重要性，显示出很强的临床实用性。
