Predictive Nomogram for Unfavorable Outcome of Spontaneous Intracerebral Hemorrhage

Liu, Mingxing; Wang, Zijun; Meng, Xiankun; Zhou, Yong; Hou, Xiaoqun; Li, Luo; Li, Tong; Chen, Feng; Xu, Zhiming; Li, Shengli; Wang, Weimin

doi:10.1016/j.wneu.2022.05.111

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…In the present study, none of the lesions has a size of more than 6 cm. In the present study, although more patients had lesions in eloquent locations, they were predominantly draining into the super cial venous system, which led to a reduced rebleeding rate compared to these reported studies [13,14,15]. The Average number of end arteries and perforators feeding the nidus was less in the present study who were treated by embolisation alone compared to the earlier reported study, which led to complete obliteration of the nidus with curative intent in nearly 90% of the patients in such circumstances [14,17,19].…”

Section: Discussioncontrasting

confidence: 62%

“…Midline shift re ecting the mass effect of intracranial bleeding puts us in a dilemma to either go for surgical or embolisation and keep the patient on conservative treatment. Studies have suggested unfavorable outcomes if the midline shift is > 4mm [11][12][13]. In the present study, all the patients who underwent embolisation had a midline shift of less than 5mm, which may have resulted in a good outcome.…”

Section: Discussionmentioning

confidence: 55%

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Comparative outcome of endovascular embolization with microsurgery in managing acute spontaneous cerebral hemorrhage in pediatric patients, an institutional experience

2022

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Introduction: A few earlier studies have reported the role of embolization with curative intent in treating the early phase of a spontaneous cerebral hemorrhage of the brain AVM in pediatric patients. its e cacy needs to be compared with microsurgery. The risk factors for hemorrhage following early embolization in such patients should be evaluated.Material & Methods: We analyzed patients treated for arteriovenous malformation in pediatrics (< 18 years) following its rupture in the acute phase by embolization alone and surgery between July 2018 and July 2022. From a pool of 80 patients who had undergone treatment for ruptured AVM with hemorrhage at our center, we identi ed 36 patients with spontaneous bleeding due to AVMs. Out of which, 20 were treated by embolization alone (Group1) and another group 2 by surgery (with and without adjuvant embolisation).Result: Spetzler martin's grading of the lesion suggested seven lesions<3 and 13 lesions ≥3 in the embolization group; similarly, seven lesions were <3 and nine≥3 Spetzler martin grade in the surgery group. The average midline shift in the embolization group was 2.12±1.68, and in the surgery group was 4.24±2.89 mm(p=0.019). Incomplete embolization was associated with hemorrhage in 2 patients treated with curative intent and 4 in the surgery group treated with embolization as adjuvant (p=0.01). Glasgow outcome score ≥4 was observed in 18 patients in embolization and 12 in the surgery group on follow-up (p=0.273). The average follow-up in the embolization group was 25.80±7.8, and in the surgery group, 29.18±11.85 months (p=0.232).Conclusions: Incomplete embolization is the signi cant risk factor associated with hemorrhage in AVMs treated following a hemorrhagic stroke in the pediatric age group. Embolization with curative intent in treating such lesions is equally e cacious to the surgery group treated earlier by adjuvant embolization with careful patient selection. Although essential, our results need a further prospective study on a large patient population with longer follow-ups.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 55%

Comparative outcome of endovascular embolization with microsurgery in managing acute spontaneous cerebral hemorrhage in pediatric patients, an institutional experience

2022

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“…Early surgery was linked to a greater risk of rebleeding, whereas delayed surgery was linked to severe consequences 11) . Moreover, in my previous paper, we found that the 21 hours of time to operation room was the turning point of outcome and the best outcome is obtainable at 12-36 hours surgery 14) . Consequently, we TOR was divided into three categories : 1) <12 hours, 2) ≥12 and ≤36 hours, and 3) >36 hours.…”

Section: Discussionmentioning

confidence: 86%

Prediction Model for Unfavorable Outcome in Spontaneous Intracerebral Hemorrhage Based on Machine Learning

Li,

Zhang,

Hou

et al. 2024

J Korean Neurosurg Soc

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Objective : The spontaneous intracerebral hemorrhage (ICH) remains a significant cause of mortality and morbidity throughout the world. The purpose of this retrospective study is to develop multiple models for predicting ICH outcomes using machine learning (ML).Methods : Between January 2014 and October 2021, we included ICH patients identified by computed tomography or magnetic resonance imaging and treated with surgery. At the 6-month check-up, outcomes were assessed using the modified Rankin Scale. In this study, four ML models, including Support Vector Machine (SVM), Decision Tree C5.0, Artificial Neural Network, Logistic Regression were used to build ICH prediction models. In order to evaluate the reliability and the ML models, we calculated the area under the receiver operating characteristic curve (AUC), specificity, sensitivity, accuracy, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR).Results : We identified 71 patients who had favorable outcomes and 156 who had unfavorable outcomes. The results showed that the SVM model achieved the best comprehensive prediction efficiency. For the SVM model, the AUC, accuracy, specificity, sensitivity, PLR, NLR, and DOR were 0.91, 0.92, 0.92, 0.93, 11.63, 0.076, and 153.03, respectively. For the SVM model, we found the importance value of time to operating room (TOR) was higher significantly than other variables.Conclusion : The analysis of clinical reliability showed that the SVM model achieved the best comprehensive prediction efficiency and the importance value of TOR was higher significantly than other variables.

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“…Multi-parametric nomogram is a graphical calculation tool which calculates the probability of an event based on individual characteristics with better visualization, as a novel prediction approach it has been commonly applied within adult stroke practice to improve predictive accuracy. 16-18 Accordingly, we aimed to identify predictors of functional outcome in Chinese patients with nontraumatic acute pICH and to construct a simple visualized nomogram approach for individualized prediction of short-term unfavorable functional prognosis.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of an MGBP Nomogram for 3-month Unfavorable Functional Prognosis Prediction of Nontraumatic Pediatric Intracerebral Hemorrhage in Chinese Patients: 10-year Experience from a National Children’s Medical Center

ZHOU

Zhang

Chen

et al. 2023

Preprint

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Background: Pediatric intracerebral hemorrhage (pICH) remains a considerable cause of mortality. This study aimed to explore functional prognosis predictors in Chinese patients with pICH and attempted to develop and validate a nomogram for estimating individual risk probability of short-term unfavorable functional prognosis.<break><break>Methods: A retrospective case-control study through records reviewing was conducted, non-neonate patients with nontraumatic pICH discharged from the Childrens Hospital of Fudan University between January 2012 and December 2021 were all originally included. The primary outcome was unfavorable functional prognosis at 3 months post pICH defined as a score of 36 as measured using the modified Rankin Scale (ranging from 0 [asymptomatic] to 6 [death]). Multivariate logistic regression analysis was performed to screen prognosis predictors, a prediction model-based nomogram was developed. Internal validation was assessed and quantified as receiver operating characteristic (ROC) curve and bootstrapped calibration curve.<break><break>Results: A total of 269 pICH patients were enrolled, the median age was 57.2 months (interquartile range, 5.4115.1), and 157 (58.4%) patients were male. The median follow-up time was 3.2 months (interquartile range, 2.83.6), 112 (41.6%) patients had unfavorable functional outcome. Cerebral vascularmalformation as etiology, modifiedGlasgow Coma Score on admission,brainstem location, and intracerebral hemorrhage volume aspercentage of total brain volume were identified as functional prognosis predictors. A nomogram was established comprising these four predictors, abbreviated to MGBP, the area under the ROC curve of the nomogram was 0.827 (95% Confidence Interval, 0.7780.877) with good calibration (P=0.803 for the Spiegelhalters Z-test). <break><break>Conclusions: The MGBP nomogram is the first model developed and validated in a consecutive cohort to predict 3-month unfavorable functional prognosis post nontraumatic pICH in Chinese children, which may provide clinicians with a potentially effective approach for early prediction and timely management of pICH.<break><break>Key words: pediatric; intracerebral hemorrhage; functional prognosis; prediction; nomogram

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Predictive Nomogram for Unfavorable Outcome of Spontaneous Intracerebral Hemorrhage

Cited by 7 publications

References 23 publications

Comparative outcome of endovascular embolization with microsurgery in managing acute spontaneous cerebral hemorrhage in pediatric patients, an institutional experience

Comparative outcome of endovascular embolization with microsurgery in managing acute spontaneous cerebral hemorrhage in pediatric patients, an institutional experience

Prediction Model for Unfavorable Outcome in Spontaneous Intracerebral Hemorrhage Based on Machine Learning

Development and Validation of an MGBP Nomogram for 3-month Unfavorable Functional Prognosis Prediction of Nontraumatic Pediatric Intracerebral Hemorrhage in Chinese Patients: 10-year Experience from a National Children’s Medical Center

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