A 90-Day Prognostic Model Based on the Early Brain Injury Indicators after Aneurysmal Subarachnoid Hemorrhage: the TAPS Score

Lin, Fa; Chen, Yu; Lu, Junlin; Han, Heze; Ma, Li; Zhao, Yahui; Yan, Debin; Li, Ruinan; Yang, Jun; He, Shihao; Li, Zhipeng; Zhang, Haibin; Yuan, Kun; Wang, Ke; Hao, Qiang; Ye, Xun; Wang, Hao; Li, Hongliang; Zhang, Linlin; Shi, Guangzhi; Zhou, Jianxin; Zhao, Yang; Zhang, Yukun; Li, Youxiang; Wang, Shuo; Zhao, Yuanli

doi:10.1007/s12975-022-01033-4

Cited by 16 publications

(18 citation statements)

References 56 publications

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“…In a prediction model proposed by Lai et al (33), although NLR was included, it was not reported how the inclusion of NLR improved the prediction efficiency of the model. Similarly, in the TAPS model presented by Li et al (34), the contribution of white blood cells (WBC) to the model was not reported. Moreover, the same predictors (NLR and WBC) presented different predictive…”

Section: Discussionmentioning

confidence: 94%

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio

et al. 2023

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ObjectiveMany peripheral inflammatory markers were reported to be associated with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to identify the most promising inflammatory factor that can improve existing predictive models.MethodsThe study was based on data from a 10 year retrospective cohort study at Sichuan University West China Hospital. We selected the well-known SAFIRE and Subarachnoid Hemorrhage International Trialists’ (SAHIT) models as the basic models. We compared the performance of the models after including the inflammatory markers and that of the original models. The developed models were internally and temporally validated.ResultsA total of 3,173 patients were included in this study, divided into the derivation cohort (n = 2,525) and the validation cohort (n = 648). Most inflammatory markers could improve the SAH model for mortality prediction in patients with aSAH, and the neutrophil-to-albumin ratio (NAR) performed best among all the included inflammatory markers. By incorporating NAR, the modified SAFIRE and SAHIT models improved the area under the receiver operator characteristics curve (SAFIRE+NAR vs. SAFIRE: 0.794 vs. 0.778, p = 0.012; SAHIT+NAR vs. SAHIT: 0.831 vs. 0.819, p = 0.016) and categorical net reclassification improvement (SAFIRE+NAR: 0.0727, p = 0.002; SAHIT+NAR: 0.0810, p < 0.001).ConclusionThis study illustrated that among the inflammatory markers associated with aSAH prognosis, NAR could improve the SAFIRE and SAHIT models for 3 month mortality of aSAH.

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Section: Discussionmentioning

confidence: 94%

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio

et al. 2023

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“…There is an increase in publications considering also neuroinflammatory parameters for an early prognosis estimation after aSAH [ 17 , 36 ]. A recently published article reports about a new comprehensive score (the TAPS score) including not only well-established parameters such as WFNS or Fisher grading but also considering early brain injury indicators such as white blood cell count, which have been demonstrated to facilitate a good 90-day outcome prediction in aSAH patients [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The value of comorbidities and illness severity scores as prognostic tools for early outcome estimation in patients with aneurysmal subarachnoid hemorrhage

et al. 2022

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Aneurysmal subarachnoid hemorrhage (aSAH) is a severe cerebrovascular disease not only causing brain injury but also frequently inducing a significant systemic reaction affecting multiple organ systems. In addition to hemorrhage severity, comorbidities and acute extracerebral organ dysfunction may impact the prognosis after aSAH as well. The study objective was to assess the value of illness severity scores for early outcome estimation after aSAH. A retrospective analysis of consecutive aSAH patients treated from 2012 to 2020 was performed. Comorbidities were evaluated applying the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification. Organ dysfunction was assessed by calculating the simplified acute physiology score (SAPS II) 24 h after admission. Modified Rankin scale (mRS) at 3 months was documented. The outcome discrimination power was evaluated. A total of 315 patients were analyzed. Significant comorbidities (CCI > 3) and physical performance impairment (ASA > 3) were found in 15% and 12% of all patients, respectively. The best outcome discrimination power showed SAPS II (AUC 0.76), whereas ASA (AUC 0.65) and CCI (AUC 0.64) exhibited lower discrimination power. A SAPS II cutoff of 40 could reliably discriminate patients with good (mRS ≤ 3) from those with poor outcome (p < 0.0001). Calculation of SAPS II allowed a comprehensive depiction of acute organ dysfunctions and facilitated a reliable early prognosis estimation in our study. In direct comparison to CCI and ASA, SAPS II demonstrated the highest discrimination power and deserves a consideration as a prognostic tool after aSAH.

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“…A higher WNFS grade implied a decreased level of consciousness and focal neurologic de cits resulting in inadequate protection re exes and risk for aspiration. Importantly, the WFNS grade is traditionally associated with a higher risk of DCI and poor outcomes, which may be associated with prolonged intubation (Li et al, 2022;Li et al, 2021). Moreover, the severity of the SAH-associated intracranial pathology increased the risk for respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

Yang

Zhao

et al. 2022

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Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage (aSAH) patients.The current conventional parameters for predicting extubation failure (EF) and extubation time may not be suitable for this population. Here, we aimed to identify factors associated with EF in aSAH patients. Methods From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021, patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred. Multivariable logistic regression was conducted to evaluate disease severity, medical history, and extubation time differences between patients with and without EF. Results Of 335 patients included, EF occurred with a rate of 0.14. The delayed cerebral ischemia (67.4% vs. 13.5%) and acute hydrocephalus (6.5% vs. 1.4%) were frequently observed in patients with EF. Also, patients who develop EF presented higher disability (65.9% vs. 17.4%) and mortality (10.9% vs. 0.7%) rates. A multivariable analysis demonstrated that age (OR 1.038; 95%CI: 1.004–1.073;P = 0.028), onset to admission time (OR 0.731; 95%CI: 0.566–0.943;P = 0.016), WNFS grade > 3 (OR 4.309; 95%CI: 1.639–11.330;P = 0.003), and extubation time < 24 h (OR 0.097; 95%CI: 0.024–0.396;P = 0.001) were significantly associated with EF occurrence. Conclusions These data provide further evidence that older aSAH patients with onset to admission time < 2days and WFNS grade > 3 have a high risk of developing EF, which is amplified by the ultra-early extubation. Moreover, in patients with two or more risk factors, a prolonged intubation recommendation requires consideration to avoid the EF.

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A 90-Day Prognostic Model Based on the Early Brain Injury Indicators after Aneurysmal Subarachnoid Hemorrhage: the TAPS Score

Cited by 16 publications

References 56 publications

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio

The value of comorbidities and illness severity scores as prognostic tools for early outcome estimation in patients with aneurysmal subarachnoid hemorrhage

Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

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