Development of a Clinical and Laboratory-Based Predictive Nomogram Model for Unfavorable Functional Outcomes Among...

Objective: This study elucidates the prognostic significance of perioperative changes in laboratory indicators for aneurysmal SAH and develops a nomogram model for outcome prediction. Methods: Aneurysmal SAH patients who received clipping or coiling at our institution between January 2016 and December 2022 were included. All patients were randomly assigned to derivation and validation cohorts. Independent predictors of unfavorable outcomes were identified by multivariate analyses. Three models were conducted to evaluate whether perioperative laboratory changes improve prediction performance. A nomogram including all independent predictors was developed in the derivation cohort and verified in both cohorts. Results: Diabetes mellitus [OR (95% CI) = 2.84 (1.44-5.59)], WFNS grade 3-5 [OR: (95% CI), 9.17 (5.49-15.33)], clipping [OR (95% CI) = 1.71 (1.03-2.85)], perioperative changes in white blood cell count [OR (95% CI) = 2.15 (1.17-3.96)], and concentrations of ALT [OR (95% CI) = 1.41 (1.04-1.91)], sodium [OR (95% CI) = 5.40 (3.01-9.71)], and glucose [OR (95% CI) = 2.18 (1.05-4.53)] were independent predictors of an unfavorable outcome. The predictive nomogram incorporated the aforementioned predictors and performed well in the derivation cohort (AUC, 0.839; 95% CI: 0.810-0.866) and the validation cohort (AUC, 0.797; 95% CI: 0.734-0.850). Conclusions: Perioperative changes in laboratory indicators can be predictors of unfavorable outcomes in aneurysmal SAH patients. The nomogram based on clinical and laboratory risk factors can be used as a convenient tool to facilitate individualized decision making.