A Scoring Model To Predict Prognosis Of Patients With Poor-grade Aneurysmal Subarachnoid Hemorrhage

Research background:Patients with poor-grade aneurysmal subarachnoid hemorrhage(a SAH)defined as World Federation of Neurosurgical Societies(WFNS)grade IV-V had high rates of disability and mortality,while heterogeneity of prognosis existed in individual.Meanwhile,the surgical and rehabilitative treatment expenses of poor-grade a SAH patients are expensive and family burden are heavy.Further study to accurately predict the prognosis of poor-grade a SAH patients,thereby guide optimum treatment and optimize medical resource allocation is necessary.Research objective:In this study,our oppose is to devise a new comprehensive scoring model to predict the prognosis of poor-grade a SAH patients.Research methods:We conducted a retrospective analysis of hospital database.From January 2013 to January 2019,a total of 147 poor-grade a SAH patients who treated at the Department of Neurosurgery of The First Affiliated Hospital of Zhejiang University medical college were enrolled as modeling cohort.Patients' demographic,medical history,imageology and laboratory examination,aneurysm information,complications,prognosis were analyzed.Risk factors for poor prognosis identified by multivariate logistic regressionwere used to devise the scoring model,and the score values of every risk factor were estimated according to each ? coefficients.A validation cohort of 68 poor-grade a SAH patients from Quzhou Municipal People's Hospital was used to validate the model's efficacy.Research results:Multivariate analysis revealed modified Fisher grade above 2(odds ratio [OR],2.972;p = 0.034),age ? 65 years(OR,3.534;p = 0.006),conservative treatment(OR,5.078;p = 0.019),WFNS Grade V(OR,2.638;p = 0.029),delayed cerebral ischemia(OR,3.170;p = 0.016),shunt-dependent hydrocephalus(OR,3.202;p = 0.032)and cerebral herniation(OR,7.337;p < 0.001)were significant predictors for poor prognosis(modified Rankin Scale [m RS] ? 3).By integration of above factors,a scoring system(total score of 0-9 points)predicting the prognosis of poor-grade a SAH patients was constructed and divided patients into three categories: low risk(0-1 point),intermediate risk(2-3 points)and high risk(4-9 points),with the risk of poor prognosis being 11%,52% and 87% respectively(P < 0.001).The area under the receiver operating characteristic curve in derivation cohort was 0.844(p < 0.001;95%CI,0.778-0.909)and Hosmer-lemeshow good of fit test showed a good calibration(p =0.589).AUC in validation cohort was 0.831(p < 0.001;95% CI,0.732-0.929)and Hosmer-lemeshow good of fit test also showed a good calibration(p = 0.984).Conclusion:The new scoring model has good discrimination and calibration,it could predict the prognosis of poor-grade a SAH patients more accurately and help decision-making for subsequent complement treatment.