Development and validation of an early predictive nomogram for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Abstract

Background: Previous studies have shown that platelet is involved in the occurrence and progression of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), but the relationship between platelet and DCI is not completely clear. Here, we aimed to screen the early platelet parameters associated with DCI after aSAH and develop an early predictive nomogram for DCI after aSAH. Methods:The study was carried out in the neurosurgery department of Affiliated Hospital of North Sichuan Medical College. A total of 285 consecutive aSAH patients admitted within 24 hours after onset were analyzed retrospectively. Univariate and multivariate analyses were used to identify risk factors for DCI.A predictive nomogram was developed and validated with R software.Results: Sixty-six (23.16%) of the 285 patients with aSAH exhibited DCI during hospitalization. The DCI group and the non-DCI group showed statistically significant differences in red blood cell count (RBC), platelet count (PLT), mean platelet volume (MPV), modified Fisher grade and platelet distribution width (PDW).Multivariable logistic regression analysis showed that modified Fisher grade [odds ratio (OR) =1.354; 95% confidence interval (CI): 1.034-1.773; P=0.028] and mean MPV [OR =1.825; P<0.001] were independent risk factors for DCI. Modified Fisher grade, RBC, PLT, MPV, and PDW were used to develop a predictive nomogram for DCI. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.799 (95% CI: 0.737-0.861) in the training set and 0.783 (95% CI: 0.616-0.949) in the validation set. The calibration curve showed that the predicted probability concurred with the actual probability. Decision curve analysis indicated that this nomogram had good clinical application value and could be used for clinical decision making.Conclusions: Our study found that MPV was an early predictor of DCI after aSAH. The nomogram incorporating early MPV had greater value in predicting DCI after aSAH.

Prognostic significance of white blood cell to platelet ratio in delayed cerebral ischemia and long-term clinical outcome after aneurysmal subarachnoid hemorrhage

“…The occurrence of DCI after aSAH has been widely reported regarding age, hydrocephalus, modified Fisher grade (mFisher) and other biomarkers. For example, Plasma Galectin-3, c-reactive protein (CRP), mean platelet volume (MPV), coagulation abnormalities, electrolyte disturbances, and neutrophil/lymphocyte ratio (NLR) are all associated with DCI or poor prognosis of aSAH (4)(5)(6)(7)(8)(9). In the latest study, some scholars found that early cerebrospinal fluid lactic acid and glucose levels also have a certain predictive effect in the occurrence of symptomatic DCI (10).…”

Postoperative red blood cell distribution width predicts functional outcome in aneurysmal subarachnoid hemorrhage after surgical clipping: A single-center retrospective study

“…RBC parameters including hemoglobin, RBC, hematocrit, MCV, MCH, mean corpuscular hemoglobin concentration (MCHC), and RDW were collected on admission and postoperatively. Other CBC parameters reported as outcome predictors were also collected, including white blood cell (WBC), neutrophil, lymphocyte, monocyte, platelet and mean platelet volume (MPV) (11)(12)(13). Differences between admission and postoperative RBC parameters were calculated by subtracting the admission values from the postoperative values.…”

“…A total of 187 patients were included in this study, of which 114 (61.0%) had good functional outcome while 73 (39.0%) had poor functional outcome, including 15 patients (8.0%) who died within 3 months of the onset (Figure 1). Of the included cases, 122 were included in a published article to establish an early predictive nomogram for DCI after aSAH (13). Parameters of demographics, addictions, medical history and aneurysm characteristics showed no significant differences between two groups.…”

Prognostic nomogram for predicting lower extremity deep venous thrombosis in ruptured intracranial aneurysm patients who underwent endovascular treatment

“…A mathematical model capable of predicting the risk of lower extremity DVT for RIA patients may be an approach to address this problem. A nomogram is a graphical depiction that presents a regression model in a friendly manner and simplifies risk assessment, providing medical staff with a user-friendly interface to map the probability of an event to individual patients, which has widely been used in intracranial aneurysms research (16)(17)(18). The purpose of this study is to develop and validate a nomogram model, thus providing a promising and facile avenue for predicting the risk of lower extremity DVT after RIA patients underwent EVT and promoting patient recovery.…”