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A predictive model in patients with chronic hydrocephalus following aneurysmal subarachnoid hemorrhage: a
1Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Insights
A new nomogram accurately predicts chronic hydrocephalus in aneurysmal subarachnoid hemorrhage (aSAH) patients using clinical and CT scan data. This tool aids in personalized treatment planning for better patient outcomes.
Area of Science:
- Neurosurgery
- Radiology
- Medical Informatics
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) can lead to chronic hydrocephalus, a serious complication.
- Accurate prediction of chronic hydrocephalus is crucial for timely intervention and management.
Purpose of the Study:
- To develop and validate a clinical-radiological nomogram for predicting chronic hydrocephalus in aSAH patients.
- To integrate computed tomography (CT) scan data with clinical information for enhanced predictive accuracy.
Main Methods:
- Retrospective analysis of 318 aSAH patients.
- Univariate, LASSO, and multivariate logistic regression to identify risk factors.
- Development and validation of a nomogram using CT-derived radiological features and clinical data.
- Evaluation of model performance using ROC curves, AUC, calibration curves, Brier scores, and Decision Curve Analysis (DCA).
Main Results:
- Identified three independent predictors for chronic hydrocephalus: Periventricular white matter changes, External lumbar drainage, and Modified Fisher Grade.
- The nomogram demonstrated good discriminative ability with AUC values of 0.810 (training) and 0.811 (testing).
- Calibration curves and Brier scores confirmed excellent agreement between predicted and observed outcomes.
- DCA indicated superior clinical utility and net benefit across various risk thresholds.
Conclusions:
- A validated clinical-radiological nomogram effectively predicts chronic hydrocephalus risk in aSAH patients.
- The nomogram integrates key clinical and CT-based radiological factors.
- This tool can assist clinicians in developing personalized treatment strategies for aSAH patients.
Objective:
Our aim was to develop a nomogram that integrates clinical and radiological data obtained from computed tomography (CT) scans, enabling the prediction of chronic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH).
Method:
A total of 318 patients diagnosed with subarachnoid hemorrhage (SAH) and admitted to the Department of Neurosurgery at the Affiliated People's Hospital of Jiangsu University between January 2020 and December 2022 were enrolled in our study. We collected clinical characteristics from the hospital's medical record system. To identify risk factors associated with chronic hydrocephalus, we conducted both univariate and LASSO regression models on these clinical characteristics and radiological features, accompanied with penalty parameter adjustments conducted through tenfold cross-validation. All features were then incorporated into multivariate logistic regression analyses. Based on these findings, we developed a clinical-radiological nomogram. To evaluate its discrimination performance, we conducted Receiver Operating Characteristic (ROC) curve analysis and calculated the Area Under the Curve (AUC). Additionally, we employed calibration curves, and utilized Brier scores as an indicator of concordance. Additionally, Decision Curve Analysis (DCA) was performed to determine the clinical utility of our models by estimating net benefits at various threshold probabilities for both training and testing groups.
Results:
The study included 181 patients, with a determined chronic hydrocephalus prevalence of 17.7%. Univariate logistic regression analysis identified 11 potential risk factors, while LASSO regression identified 7 significant risk factors associated with chronic hydrocephalus. Multivariate logistic regression analysis revealed three independent predictors for chronic hydrocephalus following aSAH: Periventricular white matter changes, External lumbar drainage, and Modified Fisher Grade. A nomogram incorporating these factors accurately predicted the risk of chronic hydrocephalus in both the training and testing cohorts. The AUC values were calculated as 0.810 and 0.811 for each cohort respectively, indicating good discriminative ability of the nomogram model. Calibration curves along with Hosmer-Lemeshow tests demonstrated excellent agreement between predicted probabilities and observed outcomes in both cohorts. Furthermore, Brier scores (0.127 for the training and 0.09 for testing groups) further validated the predictive performance of our nomogram model. The DCA confirmed that this nomogram provides superior net benefit across various risk thresholds when predicting chronic hydrocephalus. The decision curve demonstrated that when an individual's threshold probability ranged from 5 to 62%, this model is more effective in predicting the occurrence of chronic hydrocephalus after aSAH.
Conclusion:
A clinical-radiological nomogram was developed to combine clinical characteristics and radiological features from CT scans, aiming to enhance the accuracy of predicting chronic hydrocephalus in patients with aSAH. This innovative nomogram shows promising potential in assisting clinicians to create personalized and optimal treatment plans by providing precise predictions of chronic hydrocephalus among aSAH patients.
