动脉瘤性蛛网膜下腔出血介入术后不良预后风险模型的构建及评价OA
Construction and evaluation of a prognostic model for poor outcomes following endovascular treatment of aneurysmal subarachnoid hemorrhage
目的:评估动脉瘤性蛛网膜下腔出血(aSAH)患者血管内介入治疗后发生不良预后的风险因素,构建并验证一个整合术前及术后动态因素的列线图预测模型.方法:回顾性收集2015年1月至2024年4月汕头大学医学院第一附属医院收治的452例行介入治疗的aSAH患者临床资料.按7∶3比例随机分为训练集(318例)和验证集(134例).以出院时改良Rankin量表评分>2分定义为不良预后.通过单因素及多因素logistic回归分析筛选独立预测因素,并基于此构建列线图模型.采用受试者工作特征曲线下面积(AUC)评估区分度,Hosmer-Lemeshow检验和校准曲线评估校准度,决策曲线分析评估临床实用性.结果:训练集与验证集基线资料均衡可比(均P>0.05).多因素分析显示,年龄(OR=1.03,95%CI:1.01～1.06)、高Hunt-Hess分级(Ⅲ～Ⅴ级)(OR=2.02,95%CI:1.03～3.95)、高改良Fisher分级(Ⅲ～Ⅳ级)(OR=5.71,95%CI:2.64～12.36)、迟发性脑梗死(OR=4.36,95%CI:2.35～8.10)及颅内再出血(OR=3.25,95%CI:1.78～5.92)是不良预后的独立预测因素.基于此5个因素构建列线图.该模型在训练集和验证集中的AUC值分别为0.872(95%CI:0.835～0.909)和0.852(95%CI:0.782～0.921),区分度良好.校准曲线和Hosmer-Lemeshow检验(训练集P=0.109,验证集P=0.478)显示预测与实际结局一致性高.决策曲线分析表明模型在较大阈值概率范围内具有临床净获益.决策曲线分析表明,当阈值概率在6%～100%(训练集)及10%～85%(验证集)范围内时,应用本模型具有临床净获益.结论:本研究构建的列线图模型整合了年龄、入院病情严重程度及术后关键并发症,能有效预测aSAH患者介入术后的不良预后,具有良好的区分度、校准度和临床适用性,可为个体化预后评估与临床决策提供直观工具.
Objective:To assess the risk factors for poor prognosis in patients with aneurysmal subarachnoid hemorrhage(aSAH)after endovascular treatment and to construct and validate a nomogram prediction model integrating both preoperative and postoperative dynamic factors.Methods:Clinical data of 452 aSAH patients who underwent endovascular treatment at The First Affiliated Hospital of Shantou University Medical College between January 2015 and April 2024 were retrospectively collected.Patients were randomly divided into a training cohort(n=318)and a validation cohort(n=134)at a 7∶3 ratio.An unfavorable outcome was defined as a modified Rankin Scale score>2 at discharge.Independent predictors were identified through univariate and multivariate logistic regression analyses,and a nomogram model was subsequently constructed.The model's discrimination was assessed using the area under the receiver operating characteristic curve(AUC),calibration was evaluated by the Hosmer-Lemeshow test and calibration plots,and clinical utility was determined by decision curve analysis.Results:Baseline characteristics were balanced and comparable between the training and validation cohorts(all P>0.05).Multivariate analysis identified the following as independent predictors of poor prognosis:age(OR=1.03,95%CI:1.01-1.06),high Hunt-Hess grade(Ⅲ-Ⅴ)(OR=2.02,95%CI:1.03-3.95),high modified Fisher grade(Ⅲ-Ⅳ)(OR=5.71,95%CI:2.64-12.36),delayed cerebral infarction(OR=4.36,95%CI:2.35-8.10),and intracranial rebleeding(OR=3.25,95%CI:1.78-5.92).A nomogram was developed based on these five factors.The model demonstrated good discrimination,with AUC values of 0.872(95%CI:0.835-0.909)and 0.852(95%CI:0.782-0.921)in the training and validation cohorts,respectively.The calibration curves and Hosmer-Lemeshow test(training cohort P=0.109;validation cohort P=0.478)indicated good agreement between predicted and observed outcomes.Decision curve analysis showed that the model provided clinical net benefit within threshold probability ranges of 6%-100%(training cohort)and 10%-85%(validation cohort).Conclusion:The constructed nomogram,which integrates age,severity of admission condition,and key postoperative complications,can effectively predict poor prognosis in aSAH patients after endovascular treatment.It exhibits good discrimination,calibration,and clinical applicability,offering an intuitive tool for individualized prognosis assessment and clinical decision-making.
姬培培;张庆英;谭殿辉;伍艳春;陈慕媛
汕头大学医学院第一附属医院神经外科,广东 汕头 515041汕头大学医学院预防医学系,广东 汕头 515041汕头大学医学院第一附属医院神经外科,广东 汕头 515041汕头大学医学院第一附属医院护理研究院,广东 汕头 515041汕头大学医学院第一附属医院神经外科,广东 汕头 515041
医药卫生
破裂颅内动脉瘤蛛网膜下腔出血血管内治疗预后列线图
ruptured intracranial aneurysmsubarachnoid hemorrhageendovascular treatmentprognosisnomogram
《汕头大学医学院学报》 2026 (1)
24-30,37,8
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