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A Composite Model - "VASS-DCI" - for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: Role of
Prachi Sharma1, Radhakrishnan Muthuchellappan1, Thomas Francis1
1Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Background And Aims:
Existing clinical prediction tools for delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients do not integrate systemic inflammatory status, which is increasingly recognized as a contributor to DCI. We evaluated whether adding inflammatory indices, Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI), to existing tools improves DCI prediction.
Patients And Methods:
This retrospective observational study included 624 adult patients with aSAH who underwent clipping or coiling over a 2-year period. Patients were stratified into DCI and non-DCI groups. Multivariable logistic regression identified independent predictors of DCI, which were used to construct a bedside score (VASS-DCI) based on adjusted odds ratios. Receiver operating characteristic (ROC) analysis, DeLong's test, and decision curve analysis (DCA) were used to assess model performance and clinical utility.
Results:
A total of 179 patients (28.7%) developed DCI. Increasing age, VASOGRADE (yellow/red), SII ≥ 2,056,309, and SIRI ≥ 5,568 were independent predictors of DCI. A multivariable model developed using these variables significantly outperformed the VASOGRADE score (AUC 0.774 vs 0.637; p < 0.0001). DCA demonstrated a higher net clinical benefit of the full model across a threshold probability range of 10-55% compared to VASOGRADE. A clinical risk score, the VASS-DCI (range 0-6), was developed using these predictors. The score stratified patients into low (0-2), moderate (3-4), and high-risk (5-6) groups, with corresponding DCI incidences of 11.8, 48.8, and 64.3%, respectively.
Conclusion:
The VASS-DCI score integrates inflammatory, clinical, and radiological parameters into a practical bedside tool for early prediction of DCI in aSAH patients.
How To Cite This Article:
Sharma P, Muthuchellappan R, Francis T, Sharma P, Mallesha HS, Nagaraja S. A Composite Model - "VASS-DCI" - for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: Role of VASOGRADE and Inflammatory Biomarkers. Indian J Crit Care Med 2025;29(12):988-995.
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