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Tytuł:
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Development of a nomogram for predicting clinical outcome in patients with angiogram-negative subarachnoid hemorrhage.
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Autorzy:
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Zhang A; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Zhang Z; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Zhang WB; Department of Neurosurgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Zhejiang, China.
Wang X; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Lenahan C; Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, USA.; Burrell College of Osteopathic Medicine, Las Cruces, NM, USA.
Fang Y; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Luo Y; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Liu Y; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Mei S; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Chen S; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Zhang J; Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
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Źródło:
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CNS neuroscience & therapeutics [CNS Neurosci Ther] 2021 Nov; Vol. 27 (11), pp. 1339-1347. Date of Electronic Publication: 2021 Jul 28.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't; Validation Study
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Język:
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English
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Imprint Name(s):
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Original Publication: Oxford, UK : Wiley-Blackwell, c2008-
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MeSH Terms:
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Nomograms*
Predictive Value of Tests*
Subarachnoid Hemorrhage/*diagnostic imaging
Subarachnoid Hemorrhage/*therapy
Adult ; Aged ; Angiography ; Brain Edema/diagnostic imaging ; Brain Edema/etiology ; Cohort Studies ; Female ; Humans ; Male ; Mesencephalon/diagnostic imaging ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Assessment ; Treatment Outcome ; Vasospasm, Intracranial/diagnostic imaging ; Vasospasm, Intracranial/etiology
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References:
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Contributed Indexing:
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Keywords: angiogram-negative subarachnoid hemorrhage; nomograms; outcome research; prognosis
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Entry Date(s):
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Date Created: 20210728 Date Completed: 20220203 Latest Revision: 20220203
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Update Code:
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20240105
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PubMed Central ID:
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PMC8504520
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DOI:
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10.1111/cns.13712
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PMID:
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34320688
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To the best of our knowledge, this is the largest clinical retrospective study in AN-SAH patients, and is the first time to establish accurate predictive models paired with bleeding pattern.
Background: Angiogram-negative subarachnoid hemorrhage (AN-SAH) has a definite incidence of delayed cerebral ischemia (DCI) and poor clinical outcomes. The purpose is to screen independent factors and establish a nomogram to guide the clinical therapy and assess post-discharge prognosis.
Methods: We identified 273 consecutive patients referred to our institute from 2013 to 2018 for AN-SAH. A nomogram to predict poor outcomes was formulated based on the multivariable models of independent risk factors. The accuracy and discrimination of nomograms were determined in training and internal validation cohorts.
Results: The overall poor outcome rates of AN-SAH were 14.3% and 8.7% at 3 months and 12 months, respectively. In addition, perimesencephalic AN-SAH (PAN-SAH) presented with a more unfavorable prognosis compared with non-perimesencephalic AN-SAH (NPAN-SAH). The clinical prognosis was associated with the World Federation of Neurosurgical Societies scale (WFNS) (odds ratio, 3.82 [95% CI, 1.15-12.67] for 3-month outcome; and odds ratio, 31.69 [95% CI, 3.65-275.43] for 12-month outcome), Subarachnoid hemorrhage Early Brain Edema Score (SEBES) (odds ratio, 10.39 [95% CI, 1.98-54.64] for 3-month outcome; odds ratio, 10.01 [95% CI, 1.87-53.73] for 12-month outcome), and symptomatic vasospasm (odds ratio, 3.16 [95% CI, 1.03-9.70] for 3-month outcome; odds ratio, 5.15 [95% CI, 1.34-19.85] for 12-month outcome). The nomogram was constructed based on the above features, which represented great predictive value in clinical outcomes.
Conclusions: Symptomatic vasospasm, high WFNS, cerebral edema, and NPAN-SAH after hemorrhage were associated with poor outcome of AN-SAH. The nomogram with WFNS (3-5), SEBES (3-4), vasospasm, and NPAN-SAH represented a practical approach to provide individualized risk assessment for AN-SAH patients.
(© 2021 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.)
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