汕头大学医学院学报2026，Vol.39Issue(1)：24-30,37,8.DOI:10.13401/j.cnki.jsumc.2026.01.005
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
Construction and evaluation of a prognostic model for poor outcomes following endovascular treatment of aneurysmal subarachnoid hemorrhage
姬培培 1张庆英 2谭殿辉 1伍艳春 3陈慕媛1
作者信息
- 1. 汕头大学医学院第一附属医院神经外科,广东 汕头 515041
- 2. 汕头大学医学院预防医学系,广东 汕头 515041
- 3. 汕头大学医学院第一附属医院护理研究院,广东 汕头 515041
- 折叠
摘要
Abstract
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.关键词
破裂颅内动脉瘤/蛛网膜下腔出血/血管内治疗/预后/列线图Key words
ruptured intracranial aneurysm/subarachnoid hemorrhage/endovascular treatment/prognosis/nomogram分类
医药卫生引用本文复制引用
姬培培,张庆英,谭殿辉,伍艳春,陈慕媛..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[J].汕头大学医学院学报,2026,39(1):24-30,37,8.
