A novel visual dynamic nomogram to online predict the risk of unfavorable outcome in elderly aSAH patients after endovascular coiling: A retrospective study

Abstract

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is a significant cause of morbidity and mortality throughout the world. Dynamic nomogram to predict the prognosis of elderly aSAH patients after endovascular coiling has not been reported. Thus, we aimed to develop a clinically useful dynamic nomogram to predict the risk of 6-month unfavorable outcome in elderly aSAH patients after endovascular coiling.MethodsWe conducted a retrospective study including 209 elderly patients admitted to the People’s Hospital of Hunan Province for aSAH from January 2016 to June 2021. The main outcome measure was 6-month unfavorable outcome (mRS ≥ 3). We used multivariable logistic regression analysis and forwarded stepwise regression to select variables to generate the nomogram. We assessed the discriminative performance using the area under the curve (AUC) of receiver-operating characteristic and the risk prediction model’s calibration using the Hosmer–Lemeshow goodness-of-fit test. The decision curve analysis (DCA) and the clinical impact curve (CIC) were used to measure the clinical utility of the nomogram.ResultsThe cohort’s median age was 70 (interquartile range: 68–74) years and 133 (36.4%) had unfavorable outcomes. Age, using a ventilator, white blood cell count, and complicated with cerebral infarction were predictors of 6-month unfavorable outcome. The AUC of the nomogram was 0.882 and the Hosmer–Lemeshow goodness-of-fit test showed good calibration of the nomogram (p = 0.3717). Besides, the excellent clinical utility and applicability of the nomogram had been indicated by DCA and CIC. The eventual value of unfavorable outcome risk could be calculated through the dynamic nomogram.ConclusionThis study is the first visual dynamic online nomogram that accurately predicts the risk of 6-month unfavorable outcome in elderly aSAH patients after endovascular coiling. Clinicians can effectively improve interventions by taking targeted interventions based on the scores of different items on the nomogram for each variable.

Prognostic model for aneurysmal subarachnoid hemorrhage patients requiring mechanical ventilation

“…Lu et al. developed a nomogram that predicted the risk of 6‐month unfavorable outcomes (by the modified Rankin score) in older patients with aSAH after endovascular coiling 29 . Hu et al.…”

“…Lu et al developed a nomogram that predicted the risk of 6-month unfavorable outcomes (by the modified Rankin score) in older patients with aSAH after endovascular coiling. 29 Hu et al developed an online prediction tool based on a random forest model to identify patients at a high risk of delayed cerebral ischemia after aSAH. 30 Fang et al reported that elevated D-dimer levels on admission were associated with short-and long-term mortality.…”

Navigating through the paradox of choice: prediction of outcome in aneurysmal subarachnoid hemorrhage

“…In addition to the previously used ones, dynamic changes in total tau in the cerebral microdialysate [ 17 ] and the CSF arginine/ornithine ratio are among the latest areas of interest [ 18 ]. An interesting online, visual dynamic nomogram has been proposed to predict the risk of adverse outcome at 6 months in elderly patients after undergoing endovascular therapy for aneurysmal SAH [ 19 ].…”