[1]邵世珂,朱贤龙,董文胜,等.动脉瘤性蛛网膜下腔出血术后1年预后预测模型的构建和验证[J].中国临床神经外科杂志,2024,29(09):532-536540.[doi:10.13798/j.issn.1009-153X.2024.09.005]
　SHAO Shi-ke,ZHU Xian-long,DONG Wen-sheng,et al.Construction and validation of a prognostic model for one-year outcomes of patients with aneurysmal subarachnoid hemorrhage after surgery[J].,2024,29(09):532-536540.[doi:10.13798/j.issn.1009-153X.2024.09.005]
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动脉瘤性蛛网膜下腔出血术后1年预后预测模型的构建和验证()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年09期
页码:
532-536540
栏目:
论著
出版日期:
2024-09-30

文章信息/Info

Title:
Construction and validation of a prognostic model for one-year outcomes of patients with aneurysmal subarachnoid hemorrhage after surgery
文章编号:
1009-153X（2024）09-0532-05
作者:
邵世珂; 朱贤龙; 董文胜; 尹鹏; 陈德顺; 樊拥军; 仲崇佩
222000 江苏连云港，南京医科大学康达学院附属连云港市第二人民医院神经外科（邵世珂、朱贤龙、董文胜、尹　鹏、陈德顺、樊拥军、仲崇佩）
Author(s):
SHAO Shi-ke;  ZHU Xian-long;  DONG Wen-sheng;  YIN Peng;  CHEN De-shun;  FAN Yong-jun;  ZHONG Chong-pei
Department of Neurosurgery, The Second People's Hospital of Lianyungang, Kangda College of Nanjing Medical University, Lianyungang 222000, China
关键词:
动脉瘤性蛛网膜下腔出血; 预后; 危险因素; 预测模型
Keywords:
Aneurysmal subarachnoid hemorrhage;  Prognosis;  Risk factors;  Prediction model
分类号:
R 743.9; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2024.09.005
文献标志码:
A
摘要:
目的 探讨动脉瘤性蛛网膜下腔出血（aSAH）术后1年预后的影响因素，并构建列线图模型进行验证。方法 回顾性分析2018年3月至2023年12月手术治疗的180例aSAH的临床资料。术后1年，采用改良Rankin量表评分评估预后，其中0~2分为预后良好，≥3为预后不良。采用lasso和logistic模型筛选预后影响因素，并使用列线图和受试者工作特征（ROC）曲线进行验证。结果 术后1年，62例预后不良，118例预后良好。单因素分析显示，年龄、改良Fisher分级、再出血、脑积水、入院时GCS、Hunt-Hess分级、动脉瘤形状与病人预后有关（P<0.05）。lasso回归及多因素logistic回归分析显示，年龄≥60岁（OR=2.228；95% CI 1.045~4.746；P=0.038）、入院时GCS评分≤8分（OR=4.104；95% CI 1.376~12.225；P=0.012）、术前Hunt-Hess分级≥3级（OR=4.382；95% CI 2.001~9.572；P<0.001 ）是aSAH术后1年预后不良的独立危险因素。以这3个危险因素构建列线图模型，ROC曲线分析显示列线图模型预测预后不良的曲线下面积为0.794（95% CI 0.723~0.866），敏感度为771，特异度为742。结论 入院时GCS评分≤8分、入院时Hunt-Hess分级≥3级、年龄≥60岁是aSAH术后1年预后不良的独立危险因素，根据这些指标建立的预测模型对病人的预后表现出较高的预测效能。
Abstract:
Objective To investigate the risk factors affecting the 1-year prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) following surgery and to develop a nomogram model for validation. Methods The clinical data of 180 patients with aSAH who underwent surgery from March 2018 to December 2023 were retrospectively analyzed. One year post-surgery, the prognosis was assessed using the modified Rankin Scale score, where scores of 0~2 indicated a good prognosis and ≥3 indicated a poor prognosis. Lasso and logistic regression models were utilized to identify the factors influencing prognosis, and the nomogram and receiver operating characteristic (ROC) curve were employed for validation. Results One year post-surgery, 62 patients had a poor prognosis, and 118 had a good prognosis. Univariate analysis revealed that age, preoperative modified Fisher grade, rebleeding, hydrocephalus, Glasgow Coma Scale (GCS) score on admission, preoperative Hunt-Hess grade, and aneurysm shape were significantly associated with aSAH patient prognosis (P<0.05). Lasso regression and multivariate logistic regression analysis demonstrated that age ≥60 years (OR=2.228; 95% CI 1.045~4.746; P=0.038), GCS score ≤8 on admission (OR=4.104; 95% CI 1.376~12.225; P=0.012), and preoperative Hunt-Hess grade ≥3 (OR=4.382; 95% CI 2.001~9.572; P<0.001) were independent risk factors for a poor prognosis of patients with aSAH one year after surgery. A nomogram model was constructed based on these three risk factors. ROC curve analysis indicated that the area under the curve for predicting a poor prognosis using the nomogram model was 0.794 (95% CI 0.723~0.866), with a sensitivity of 77.1% and a specificity of 74.2%. Conclusion A GCS score ≤8 on admission, a preoperative Hunt-Hess grade ≥3, and age ≥60 years are independent risk factors for a poor prognosis of patients with aSAH one year after surgery. The prediction model based on these indicators demonstrates high predictive efficacy for patient prognosis.

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备注/Memo

备注/Memo:
（2024-05-13收稿，2024-08-06修回）
基金项目：江苏省基础研究计划自然科学基金（BK20211275）
通信作者：仲崇佩，Email：zcp130809@163.com
更新日期/Last Update: 2024-09-30