The Role of VASOGRADE as a Simple Grading Scale to Predict Delayed Cerebral Ischemia and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Souza, Natália Vasconcellos de Oliveira; Rouanet, Carolina; Solla, Davi Jorge Fontoura; Lima, Caio Vinícius Barroso de; Souza, Caio Augusto de; Rezende, Flávio; Alves, Maramelia Miranda; Manuel, Airton Leonardo de Oliveira; Chaddad-Neto, Feres; Frudit, Michel Eli; Silva, Gisele Sampaio

doi:10.1007/s12028-022-01577-1

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…A high WFNS rating and a Fisher score often mean more severe disease levels. 29,30 Higher bleeding in subarachnoid hemorrhage is associated with poor prognosis. Previous studies have demonstrated that WFNS and Fisher grades are independent risk factors for DCI prediction.…”

Section: Discussionmentioning

confidence: 99%

A comprehensive prognostic model for delayed cerebral ischemia in rupture intracranial aneurysms after surgical clipping

Zheng,

Zhou,

Zhao

et al. 2023

Preprint

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Background and Objectives: Delayed cerebral ischemia (DCI), one of the most common complications following aneurysmal subarachnoid hemorrhage (SAH), was strongly related to poor patient outcomes. Identifying predictive factors for its occurrence is crucial for improving patient care and outcomes. Our research aimed to explore risk factors for delayed cerebral ischemia in aneurysm patients after surgical clipping and developed a prediction model. Methods: The datasets used in this study are available from the corresponding author upon reasonable request. Patients demographics, aneurysm features, comorbidities, clinical manifestations, imaging features, blood pressure on admission，incidence of DCI, and interventions were recorded. SAH patients were randomly assigned to the training or validation cohort based on a ratio of 7:3, which was implemented as internal validations for the final predictive models. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve. Results: A total of 272 patients were included in our research. The final logistic model included 7 independent predictors (Age, Smoking, Drinking, WFNS, Fisher, MAP on Second postoperative day, and Na) and was developed as a simple-to-use nomogram. The training set and validation set model's C-index are 0.844 and 0.766, demonstrating moderate predictive ability with regard to risks of DCI. Conclusion: We developed a model with seven independent risk factors to predict the incidence of DCI. We focused on exploring the postoperative status in DCI patients. Elevated blood pressure on the second postoperative day may indicate the early occurrence of microvascular spasm.

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Section: Discussionmentioning

confidence: 99%

A comprehensive prognostic model for delayed cerebral ischemia in rupture intracranial aneurysms after surgical clipping

Zheng,

Zhou,

Zhao

et al. 2023

Preprint

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“…The perception of aSAH patients has evolved in parallel with the widespread use of mixed scales in various combinations. Examples of these multidimensional models include HAIR [39], VASOGRADE [40], HATCH [41], or EDCI [42] scales. However, it is important to note that these scales have their limitations and exhibit significant heterogeneity within study groups, particularly during the assessment phase [43].…”

Section: Discussionmentioning

confidence: 99%

The Role of Early Serum Biomarkers and Clinical Rating Scales in the Prediction of Delayed Cerebral Ischaemia and Short-Term Outcome after Aneurysmal Subarachnoid Haemorrhage: Single Centre Experience

Burzyńska,

Uryga,

Woźniak

et al. 2023

JCM

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Considering the variety of complications that arise after aneurysmal subarachnoid haemorrhage (aSAH) and the complex pathomechanism of delayed cerebral ischaemia (DCI), the task of predicting the outcome assumes a profound complexity. Therefore, there is a need to develop early predictive and decision-making models. This study explores the effect of serum biomarkers and clinical scales on patients’ outcomes and their interrelationship with DCI and systemic complications in aSAH. This was a retrospective analysis including aSAH patients admitted to the Wroclaw University Hospital (Wrocław, Poland) from 2011 to 2020. A good outcome was defined as a modified Rankin Scale (mRS) score of 0–2. The prediction of the development of DCI and poor outcome was conducted using logistic regression as a standard model (SM) and random forest as a machine learning method (ML). A cohort of 174 aSAH patients were included in the analysis. DCI was diagnosed in 79 (45%) patients. Significant differences between patients with poor vs. good outcome were determined from their levels of albumin (31 ± 7 vs. 35 ± 5 (g/L); p < 0.001), D-dimer (3.0 ± 4.5 vs. 1.5 ± 2.8 (ng/mL); p < 0.001), procalcitonin (0.2 ± 0.4 vs. 0.1 ± 0.1 (ng/mL); p < 0.001), and glucose (169 ± 69 vs. 137 ± 48 (nmol/L); p < 0.001). SM for DCI prediction included the Apache II scale (odds ratio [OD] 1.05; 95% confidence interval [CI] 1.00–1.09) and albumin level (OD 0.88; CI 0.82–0.95). ML demonstrated that low albumin level, high Apache II scale, increased D-dimer and procalcitonin levels had the highest predictive values for DCI. The integration of clinical parameters and scales with a panel of biomarkers may effectively facilitate the stratification of aSAH patients, identifying those at high risk of secondary complications and poor outcome.

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“…The main risk factors for occurrence of DCI are the clinical condition on admission and the amount of SAH on the computed tomography (CT) scan [ 16 , 17 , 19 , 20 ] (Tables 1 and 2 ). Other factors, such as smoking, diabetes, systemic inflammatory response syndrome, hyperglycemia, and hydrocephalus, have shown moderate to strong association with DCI [ 21 ].…”

Section: Risk Prediction Of DCImentioning

confidence: 99%

Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention

et al. 2023

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Introduction Delayed cerebral ischemia (DCI) is a major determinant for poor neurological outcome after aneurysmal subarachnoid hemorrhage (aSAH). Detection and treatment of DCI is a key component in the neurocritical care of patients with aSAH after initial aneurysm repair. Methods Narrative review of the literature. Results Over the past 2 decades, there has been a paradigm shift away from macrovascular (angiographic) vasospasm as a main diagnostic and therapeutic target. Instead, the pathophysiology of DCI is hypothesized to derive from several proischemic pathomechanisms. Clinical examination remains the most reliable means for monitoring and treatment of DCI, but its value is limited in comatose patients. In such patients, monitoring of DCI is usually based on numerous neurophysiological and/or radiological diagnostic modalities. Catheter angiography remains the gold standard for the detection of macrovascular spasm. Computed tomography (CT) angiography is increasingly used instead of catheter angiography because it is less invasive and may be combined with CT perfusion imaging. CT perfusion permits semiquantitative cerebral blood flow measurements, including the evaluation of the microcirculation. It may be used for prediction, early detection, and diagnosis of DCI, with yet-to-prove benefit on clinical outcome when used as a screening modality. Transcranial Doppler may be considered as an additional noninvasive screening tool for flow velocities in the middle cerebral artery, with limited accuracy in other cerebral arteries. Continuous electroencephalography enables detection of early signs of ischemia at a reversible stage prior to clinical manifestation. However, its widespread use is still limited because of the required infrastructure and expertise in data interpretation. Near-infrared spectroscopy, a noninvasive and continuous modality for evaluation of cerebral blood flow dynamics, has shown conflicting results and needs further validation. Monitoring techniques beyond neurological examinations may help in the detection of DCI, especially in comatose patients. However, these techniques are limited because of their invasive nature and/or restriction of measurements to focal brain areas. Conclusion The current literature review underscores the need for incorporating existing modalities and developing new methods to evaluate brain perfusion, brain metabolism, and overall brain function more accurately and more globally.

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The Role of VASOGRADE as a Simple Grading Scale to Predict Delayed Cerebral Ischemia and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Cited by 7 publications

References 26 publications

A comprehensive prognostic model for delayed cerebral ischemia in rupture intracranial aneurysms after surgical clipping

A comprehensive prognostic model for delayed cerebral ischemia in rupture intracranial aneurysms after surgical clipping

The Role of Early Serum Biomarkers and Clinical Rating Scales in the Prediction of Delayed Cerebral Ischaemia and Short-Term Outcome after Aneurysmal Subarachnoid Haemorrhage: Single Centre Experience

Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention

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