Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

Lu, Xiang; Zhang, Wenbo; Ye, Min; Li, Xiaoping; Luo, Xingda

doi:10.1002/jcla.23542

Cited by 11 publications

(9 citation statements)

References 47 publications

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“…However, the NLR in patients with an unfavorable prognosis was higher than that in patients with a favorable prognosis in the training cohort ( p = 0.005). Our study identified NLR on admission as an independent risk factor for unfavorable prognosis, similar to previous findings ( 4 , 7 , 33 , 34 ). Lai et al reported that a high NLR on admission could increase the risk of poor prognosis 3 months postoperatively.…”

Section: Discussionsupporting

confidence: 92%

“…These factors were selected using univariate and multivariate logistic analyses. Lai et al conducted a predicting model for aSAH prognosis, which included the GCS score, surgical clipping, and NLR ( 7 ). These independent prognostic variables were also selected by multivariate logistic regression.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, predictive models combining multiple independent predictors have been used to predict prognosis. However, these predictive models lack calibration tests, model external validation, or evaluation of their clinical usefulness; therefore, the accuracy and practicability of the models are difficult to assess ( 7 , 8 ). High-quality predictive models are necessary to guide clinical decision-making, personal care, and patient management ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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An Externally Validated Dynamic Nomogram for Predicting Unfavorable Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Liu

et al. 2021

Front. Neurol.

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Background: Aneurysmal subarachnoid hemorrhage (aSAH) leads to severe disability and functional dependence. However, no reliable method exists to predict the clinical prognosis after aSAH. Thus, this study aimed to develop a web-based dynamic nomogram to precisely evaluate the risk of poor outcomes in patients with aSAH.Methods: Clinical patient data were retrospectively analyzed at two medical centers. One center with 126 patients was used to develop the model. Least absolute shrinkage and selection operator (LASSO) analysis was used to select the optimal variables. Multivariable logistic regression was applied to identify independent prognostic factors and construct a nomogram based on the selected variables. The C-index and Hosmer–Lemeshow p-value and Brier score was used to reflect the discrimination and calibration capacities of the model. Receiver operating characteristic curve and calibration curve (1,000 bootstrap resamples) were generated for internal validation, while another center with 84 patients was used to validate the model externally. Decision curve analysis (DCA) and clinical impact curves (CICs) were used to evaluate the clinical usefulness of the nomogram.Results: Unfavorable prognosis was observed in 46 (37%) patients in the training cohort and 24 (29%) patients in the external validation cohort. The independent prognostic factors of the nomogram, including neutrophil-to-lymphocyte ratio (NLR) (p = 0.005), World Federation of Neurosurgical Societies (WFNS) grade (p = 0.002), and delayed cerebral ischemia (DCI) (p = 0.0003), were identified using LASSO and multivariable logistic regression. A dynamic nomogram (https://hu-ping.shinyapps.io/DynNomapp/) was developed. The nomogram model demonstrated excellent discrimination, with a bias-corrected C-index of 0.85, and calibration capacities (Hosmer–Lemeshow p-value, 0.412; Brier score, 0.12) in the training cohort. Application of the model to the external validation cohort yielded a C-index of 0.84 and a Brier score of 0.13. Both DCA and CIC showed a superior overall net benefit over the entire range of threshold probabilities.Conclusion: This study identified that NLR on admission, WFNS grade, and DCI independently predicted unfavorable prognosis in patients with aSAH. These factors were used to develop a web-based dynamic nomogram application to calculate the precise probability of a poor patient outcome. This tool will benefit personalized treatment and patient management and help neurosurgeons make better clinical decisions.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An Externally Validated Dynamic Nomogram for Predicting Unfavorable Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Liu

et al. 2021

Front. Neurol.

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“…The characteristics of the included studies are summarized in Table 1. We included 10 studies consisting of 4,140 patients in this meta-analysis (10,(20)(21)(22)(23)(24)(25)(26)(27)(28). Nine studies investigated the association between NLR and poor functional outcome (10,(20)(21)(22)(23)(24)(26)(27)(28), and six studies investigated the association between NLR and DCI (20,22,(25)(26)(27).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We included 10 studies consisting of 4,140 patients in this meta-analysis (10,(20)(21)(22)(23)(24)(25)(26)(27)(28). Nine studies investigated the association between NLR and poor functional outcome (10,(20)(21)(22)(23)(24)(26)(27)(28), and six studies investigated the association between NLR and DCI (20,22,(25)(26)(27). Most of the studies were retrospective observational studies, and only three studies were prospective studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2021

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The neutrophil–to-lymphocyte ratio (NLR), as an essential systemic inflammation factor, has been widely used as a prognostic indicator in various diseases, such as malignant tumors, cardiovascular disease, and intracranial hemorrhage. An increasing number of studies have believed that NLR is a valuable predictor of prognosis for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, these results remain controversial. In the current study, we planned to carry out a systematic review and meta-analysis to investigate the association between NLR and poor outcome, and the occurrence of delayed cerebral ischemia (DCI). We carried out a comprehensive search for published literatures on PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to April 1, 2021. We conducted an assessment of all included studies based on the principles proposed in the Newcastle-Ottawa Quality Assessment Scale (NOS). Poor outcome and the occurrence of DCI were considered as the main outcome measure. We calculated the pooled odds ratio (OR) and corresponding 95% confidence interval (CI) to examine the strength of the association of NLR with poor outcome or the occurrence of DCI. We strictly selected a total of 10 studies comprising 4,989 patients. Nine studies reported the association between NLR and poor outcome, and five studies reported the association between NLR and the occurrence of DCI. The pooled results indicated higher NLR was significantly associated with both poorer outcomes (OR = 1.32, 95%CI 1.11–1.57; P = 0.002, I2 = 87%), and the occurrence of DCI (OR = 1.72, 95%CI 1.22–2.41; P = 0.002, I2 = 82%) in aSAH patients. The NLR is a valuable indicator of inflammation to independently predict poor outcome and occurrence of DCI after aSAH, where a higher NLR is significantly associated with poor outcomes and occurrence of DCI. These findings suggest that the NLR can help clinicians evaluate the prognosis and identify potentially severe patients early, which may contribute to better management and improve poor prognosis of aSAH patients.

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Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

Zhang

et al. 2020

Clinical Laboratory Analysis

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Aneurysmal subarachnoid hemorrhage (aSAH) is an acute cerebrovascular disease that seriously damages the central nervous system and simultaneously exerts pathophysiological effects on multiple organs of the body, with high mortality and morbidity. 1,2 Approximately onethird of the survivors suffer from severe disability and functional dependency. 3 Rebleeding is a major early complication of aSAH with the incidence of 6%-23%, which most occurs within 72 hours of onset. 4,5 Previous studies reported that the mortality was 50%-60% in the presence of rebleeding. 4-6 To date, craniotomy clipping and endovascular embolization serve as main treatments for aSAH to prevent and treat complications such as rebleeding, vasospasm and hydrocephalus, and to reduce the occurrences of deaths and disabilities. 7-11 Although improvements in intensive care and treatments in recent years, the prognosis is still a frequent concern for aSAH. To the best of our knowledge,

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Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

Cited by 11 publications

References 47 publications

An Externally Validated Dynamic Nomogram for Predicting Unfavorable Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

An Externally Validated Dynamic Nomogram for Predicting Unfavorable Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies

Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

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