Materiały źródłowe

• #1 Prediction of Outcomes for Ruptured Aneurysm Surgery – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30776998/

  Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. […] The Southwestern Aneurysm Severity Index predicts Glasgow Outcome Score at 1 year with good discrimination (area under the receiver operating characteristic curve, derivation: 0.816, 95% CI, 0.759-0.873; validation: 0.803, 95% CI, 0.746-0.861) and accurate calibration ( R2=0.939). […] The Southwestern Aneurysm Severity Index has been internally validated to predict 1 year Glasgow Outcome Scores at initial presentation, thus optimizing patient or family counseling and possibly guiding therapeutic efforts.

• #1 Predicting outcome after aneurysmal subarachnoid hemorrhage by exploitation of signal complexity: a prospective two-center cohort study | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-024-04939-7

  Signal complexity (i.e. entropy) describes the level of order within a system. Low physiological signal complexity predicts unfavorable outcome in a variety of diseases and is assumed to reflect increased rigidity of the cardio/cerebrovascular system leading to (or reflecting) autoregulation failure. […] Aneurysmal subarachnoid hemorrhage (aSAH) remains a serious disease with often poor prognosis even after successful securing of the aneurysm. […] The paramount goal of neurocritical care is to predict, counteract or even prevent these secondary injuries to improve patients outcome. […] MSE metrics and thereby complexity of physiological signals are independent, internally and externally valid predictors of 12-month outcome. […] The promising results of this study warrant further investigation into the cause of the resulting complexity as well as its association with important and potentially preventable complications (i.e. vasospasm and DCI).

• #2 Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study | The BMJ

  https://www.bmj.com/content/360/bmj.j5745

  Objective To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH). […] Clinical prediction models were developed with individual patient data from 10936 patients and validated with data from 3355 patients after development of the model. […] The prediction models reliably estimate the outcome of patients who were managed in various settings for ruptured intracranial aneurysms that caused subarachnoid haemorrhage. […] The web based SAHIT prognostic calculator (http://sahitscore.com) and the related app could be adjunctive tools to support management of patients. […] The models were well calibrated and had good discrimination. […] The externally validated AUC was 0.80-0.81 for the models to predict functional outcome and 0.76-0.78 for the models to predict mortality. […] The predictor items are assessable at hospital admission. […] The SAHIT prediction models were based on patient data from different regions and settings of care and included 10936 patients in the development set; they reliably estimated outcome in 3355 patients in the validation set.

• #3 Explainable machine learning in outcome prediction of high-grade aneurysmal subarachnoid hemorrhage | Aging

  https://www.aging-us.com/full/205621

  Objective: Accurate prognostic prediction in patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) is essential for personalized treatment. In this study, we developed an interpretable prognostic machine learning model for high-grade aSAH patients using SHapley Additive exPlanations (SHAP). […] Results: Among the 421 patients, 204 (48.5%) exhibited poor prognosis. The RF model demonstrated superior performance compared to LR (AUC = 0.850, 95% CI: 0.783-0.918), SVM (AUC = 0.862, 95% CI: 0.799-0.926), and XGBoost (AUC = 0.850, 95% CI: 0.783-0.917) with an AUC of 0.867 (95% CI: 0.806-0.929). Primary prognostic features identified through SHAP analysis included higher World Federation of Neurosurgical Societies (WFNS) grade, higher modified Fisher score (mFS) and advanced age, were found to be associated with 12-month unfavorable outcome, while the treatment of coiling embolization for aSAH drove the prediction towards favorable prognosis. Additionally, the SHAP force plot visualized individual prognosis predictions.

• #4 < ?php wp_title( '|', true, 'right' ); ?>

  https://surgicalneurologyint.com/surgicalint-articles/clinical-outcome-prediction-in-aneurysmal-subarachnoid-hemorrhage-alterations-in-brain-body-interface/

  Clinical outcome prediction in aneurysmal subarachnoid hemorrhage Alterations in brainbody interface. […] Brainbody associations are essential in influencing outcome in patients with ruptured brain aneurysms. […] Binary logistic regression main effects model included four statistically significant single prognostic variables, namely, neurological grade, age, stroke, and time to surgery. […] Using the aforementioned results generated from binary logistic regression models, we can identify potential patients who are in the high risk group of neurological deterioration. […] Patients with ruptured brain aneurysms and associated subarachnoid hemorrhage (SAH) have a mortality rate of at least 45% in the first month after rupture. […] The multivariable binary logistic regression model found four statistically significant single prognostic variables, namely, admission neurological grade, age, time to surgery and post-admission stroke, and four significant interaction terms.

• #5 < ?php wp_title( '|', true, 'right' ); ?>

  https://surgicalneurologyint.com/surgicalint-articles/clinical-outcome-prediction-in-aneurysmal-subarachnoid-hemorrhage-alterations-in-brain-body-interface/

  The odds of poor outcome associated with one unit increase in neurological grade is increased by a factor of 2.06. […] The odds of poor outcome is increased by a factor of 4.0 when the aneurysmal SAH patient experiences post-hospital admission stroke. […] This study also demonstrates that the odds of poor neurological outcome is increased by a factor of 4 in aneurysmal SAH patients who develop post-admission strokes. […] We also make the observation that development of cerebral edema, in the context of history of hypertension and liver disease, has significant impact on neurologic outcome deterioration in aneurysmal SAH. […] This study also makes the novel observation that development of cerebral edema in aneurysmal SAH patients with a history of liver dysfunction markedly increases likelihood for poor outcome.

• #6 Prognostic prediction models for endovascular abdominal aortic aneurysm repair: protocol for a scoping review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36307155/

  Endovascular aneurysm repair (EVAR) has a marked short-term advantage over open surgical repair in managing abdominal aortic aneurysms (AAA); however, this benefit is lost in the long term. […] The current trend towards stratified medicine has given rise to diverse prognostic prediction models and scoring systems for EVAR. These models could act as decision support tools that employ patient and operative factors, to improve long-term outcomes. […] Past literature evaluated and compared model performance for predicting one outcome, for example, mortality. None were deemed competent for clinical application. […] The proposed study will use a scoping review approach to capture literature on prognostic modelling in EVAR for all predictable outcomes. The results are anticipated to inform future research, identify knowledge gaps, and assist in determining the potential of models for clinical use.

• #7 Machine learning based outcome prediction of microsurgically treated unruptured intracranial aneurysms | Scientific Reports

  https://www.nature.com/articles/s41598-023-50012-8

  Machine learning (ML) has revolutionized data processing in recent years. This study presents the results of the first prediction models based on a long-term monocentric data registry of patients with microsurgically treated unruptured intracranial aneurysms (UIAs) using a temporal train-test split. […] The present results showed good performance in predicting functional and clinical outcomes after microsurgical therapy of UIAs in the internal data set, especially for the main outcome parameters, mRS and permanent neurological deficit. […] The external validation showed poor discrimination with ROC-AUC values of 0.61, 0.53 and 0.58 respectively for predicting a postoperative mRS2, a pre- and postoperative difference in mRS1 point and a GOS5. Therefore, generalizability of the models could not be demonstrated in the external validation.

• #8 Machine learning based outcome prediction of microsurgically treated unruptured intracranial aneurysms | Scientific Reports

  https://www.nature.com/articles/s41598-023-50012-8

  The aim of this study was to demonstrate that the prediction of early clinical and functional endpoints after microsurgical clipping of UIAs is feasible using advanced ML techniques. […] Our models showed an excellent or at least acceptable discrimination performance for the most important outcome parameters, such as permanent nND, postoperative mRS, and mRS difference. […] In our study, the prediction model for postoperative mRS scores reached a value of 0.870.03 and shows therefore excellent discrimination. […] To our knowledge, this is the first study to present ML-based prediction models for functional and clinical outcomes in a large sample of microsurgically treated UIAs using a temporal split. […] Unfortunately, the excellent models could not be generalized in the external validation data set of an independent neurosurgical department due to major differences between the treated patients and aneurysms in the departments.

• #9 Explainable machine learning in outcome prediction of high-grade aneurysmal subarachnoid hemorrhage | Aging

  https://www.aging-us.com/full/205621

  Conclusions: This study demonstrated the potential of machine learning techniques in prognostic prediction for high-grade aSAH patients. The features identified through SHAP analysis enhance model interpretability and provide guidance for clinical decision-making. […] The features specifically associated with poor prognosis included WFNS grade 5, age, mFS grade 4, hypertension, and aneurysm multiplicity. Each of these features exhibited a positive impact and drive the prediction towards poor prognosis. Additionally, treatment of coiling embolization, WFNS grade 2, female gender exhibited a negative impact and drove the prediction towards favorable prognosis. […] In summary, our study established four ML models (LR, SVM, RF, XGBoost) and selected the RF model to conduct a comprehensive SHAP analysis based on its superior predictive performance. The SHAP analysis revealed the significant contributions of clinical features in predicting long-term prognosis in high-grade aSAH. Elevated WFNS grades and mFS, along with advanced age, were associated with unfavorable outcomes, indicating aggravated neurological impairment and bleeding severity. Conversely, the strategic implementation of endovascular coiling emerges as a promising method to improve patient prognosis by preventing rebleeding and mitigating associated complication. Incorporating these insights into clinical decision-making holds great potential to guide therapeutic strategies and optimize patient neurocritical care.

• #10 Neurological intervention transition model for dynamic prediction of good outcome in spontaneous subarachnoid haemorrhage | Scientific Reports

  https://www.nature.com/articles/s41598-024-51684-6

  Deterioration of neurovascular conditions can be rapid in patients with spontaneous subarachnoid haemorrhage (SAH) and often lead to poor clinical outcomes. […] This study incorporated baseline clinical conditions, repeatedly measured neurological grades and haematological biomarkers for dynamic outcome prediction in patients with spontaneous SAH. […] A dynamic prognostic model predicting outcome of patients was developed based on combination of Cox model and piecewise linear mixed-effect models to incorporate different types of prognostic information. […] Incorporation of neurological intervention as an intermediate event increases the prediction performance compared with baseline joint modelling approach. […] The model proposed in this study can provide dynamic prognosis for spontaneous SAH patients and significant potential benefits in critical care management.

• #11 Neurological intervention transition model for dynamic prediction of good outcome in spontaneous subarachnoid haemorrhage | Scientific Reports

  https://www.nature.com/articles/s41598-024-51684-6

  The proposed prognostic model takes various clinical conditions on admission, multiple dynamic factors providing up-to-date prognostic information, and the effect of neurological interventions into account for prognostication. […] The multivariate NIT joint model, incorporating GCS score, WBC and glucose as dynamic prognostic covariates is the optimal model in this study, increasing the predictive accuracy of outcome from 0.7422, in baseline joint model only considering the neurological grades of patients, to 0.7783. […] This finding was consistent with the fact that neurological scales are widely used clinical tools for prognosis of SAH, which estimated patients clinical outcomes based on results in neurological assessments. […] The optimal NIT joint model is composed of five baseline covariates, i.e., cerebral oedema, cerebral infarction, respiratory failure, hydrocephalus and vasospasm, three dynamic covariates, i.e., GCS score, WBC and glucose, and a state transition indicator, i.e., intermediate event of neurological intervention.

• #12

  https://scispace.com/papers/altered-expression-of-microrna-15a-and-kruppel-like-factor-4-1raefkwp8d

  Diagnostic and prognostic potential of circulating miRNAs for intracranial aneurysms […] Circulating miRNAs are considered as new potential biomarkers of interest in many diseases, including IA, because of their involvement in the pathogenesis of IAs. […] Elevated miR-9 in Cerebrospinal Fluid Is Associated with Poor Functional Outcome After Subarachnoid Hemorrhage. […] MiR-9-3p and miR-5p are elevated in the CSF following SAH and this elevation is associated with a poor functional outcome, which has potential roles in the progression of cerebral injury and could add to early prognostication. […] MicroRNAs as Biomarkers for Predicting Complications following Aneurysmal Subarachnoid Hemorrhage. […] Aneurysmal subarachnoid hemorrhage (aSAH) is a high mortality hemorrhagic stroke that affects nearly 30,000 patients annually in the United States.

• #13

  https://journals.lww.com/md-journal/fulltext/2016/02150/prognosis_predicting_score_for_endovascular.14.aspx

  The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT. […] The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, HuntHess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. […] Our study indicated that age, hypertension, HuntHess scale, Fisher scale, aneurysm location, and periprocedural complications were independent risk factors of poor outcome for elderly aSAH patients underwent EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application.

• #14 < ?php wp_title( '|', true, 'right' ); ?>

  https://surgicalneurologyint.com/surgicalint-articles/clinical-outcome-prediction-in-aneurysmal-subarachnoid-hemorrhage-alterations-in-brain-body-interface/

  Seizures post-aneurysmal SAH increase mortality. […] In this study, we observed that seizures increase the odds of poor outcome by a factor of 1.68. […] Finally, our analysis makes the observation that seizures in the setting of history of myocardial infarction increase the odds of poor outcome by a factor of 3.05.

• #15 Outcome prediction of intracranial aneurysm treatment by flow diverters using machine learning in: Neurosurgical Focus Volume 45 Issue 5 (2018) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/45/5/article-pE7.xml

  Flow diverters (FDs) are designed to occlude intracranial aneurysms (IAs) while preserving flow to essential arteries. Incomplete occlusion exposes patients to risks of thromboembolic complications and rupture. A priori assessment of FD treatment outcome could enable treatment optimization leading to better outcomes. […] Aneurysms were classified as occluded (n = 63) or residual (incomplete occlusion, n = 21). […] Significance tests yielded 2 morphological (ostium ratio and neck ratio) and 3 hemodynamic (pre-treatment inflow rate, post-treatment inflow rate, and post-treatment aneurysm averaged velocity) discriminants between the occluded (good-outcome) and the residual (bad-outcome) group. […] NN and Gaussian-SVM models incorporating all 16 morphological, hemodynamic, and FD-related parameters predicted 6-month occlusion outcome of FD treatment with 90% accuracy. More robust models using the computational workflow and machine learning could be trained on larger patient databases toward clinical use in patient-specific treatment planning and optimization.

• #16

  https://link.springer.com/article/10.1007/s00701-024-05909-2

  Despite aneurysmal subarachnoid haemorrhage (aSAH) patients often experiencing physical and mental disabilities impacting their quality of life (QoL), routine assessment of long-term QoL data and predictive tools are limited. […] This study found no correlation between FRESH scores and validated QoL tools in a European population of aSAH patients. The study highlights the complexity of reliable long-term QoL prognostication in aSAH patients and emphasises the need for further prospective research to also focus on QoL as an important outcome parameter. […] No significant correlation could be detected between the actual clinical long-term outcome, as assessed by mRS on average 46 months after aneurysm rupture, and the prognosticated outcome after aSAH as calculated by the FRESH score. […] No significant correlation was found between the assessed parameters of cognitive performance and the QoL after an average follow-up of 46 months and the FRESH-cog, respectively, the FRESH-quol score. […] The analysis failed to show a significant correlation between the predicted outcome and QoL by the FRESH scores and the actually assessed clinical outcome, and we discussed several possible causes for that observation.

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