Abstract
Objective: A reliable prediction of clinical outcome is important for clinicians to set appropriate medical strategies in treating patients with aneurysmal subarachnoid hemorrhage (aSAH). In this study, we aim to establish a perioperative nomogram involving serum lipid signatures for predicting poor outcomes at 3 months in patients with aSAH following endovascular therapy.Methods: Data of patients with aSAH receiving endovascular therapy were collected. Univariable and multivariable analyses were performed to screen independent predictors related to unfavorable outcomes defined by the modified Rankin Scale (mFS) ≥3. A novel nomogram based on these significant features was conducted. The clinical application of this nomogram was assessed by decision curve analysis (DCA) and clinical impact curve.Results: A total number of patients included in this study were 213 (average age 58.9 years, 65.7% female), representing a poor 3-month outcome rate of 48.8%. Free fatty acid (FFA) levels on admission were efficient in predicting poor outcomes compared with other contents in serum lipids. Univariable and multivariable analyses revealed advanced age (P = 0.034), poor Hunt Hess (HH) (odds ratio, OR = 3.7, P < 0.001) and mFS (OR = 6.0, P < 0.001), aneurysms in the posterior circulation (OR = 4.4, P = 0.019), and higher FFA levels on admission (OR = 3.1, P = 0.021) were negative independent predictors of poor 3 months outcome. A novel nomogram composed of these significant features presented a concordance index (C-index) of 0.831 while the practical benefit was validated by DCA and clinical impact curve. An online calculator based on R programming promoted the clinical application of this nomogram.Conclusion: Nomogram involving age, HH grade, mFS, aneurysm location, and serum FFA levels was sufficient to provide an individualized prediction of 3-month poor outcome for each patient with aSAH who underwent endovascular therapy.
Highlights
Aneurysmal subarachnoid hemorrhage is a devastating stroke with high mortality and morbidity rate [1]
The following were the inclusion criteria: [1] admitted to an emergency room within 24 h of first symptom onset; [2] aneurysmal subarachnoid hemorrhage (aSAH) confirmed by computed tomography (CT) and digital subtraction angiography (DSA); [3] received endovascular coiling for ruptured aneurysm within 24 h; [4] blood samples including lipid profile extracted before surgery; [5] age ≥18
According to DSA records, most intracranial aneurysms were located in anterior circulation (190/213, 89.2%) compared with those in the posterior circulation (23/213, 10.8%)
Summary
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating stroke with high mortality and morbidity rate [1]. It is critical to establish better predictive models to identify the patients at risk of poor outcomes based on more comprehensive clinical and economic factors, further guiding the appropriate inpatient management. The largest case-control clinical study to date reported that both a higher high-density lipoproteins cholesterol (HDL-c) level and the administration of lipid-lowering agents are associated with a significantly lower risk of incidence of aSAH [10]. Few studies have focused on the role of abnormal lipid profiles in predicting the clinical outcome of aSAH following endovascular treatment. Validated models including dyslipidemia parameters suitable for aSAH outcome prediction are relatively scarce
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