Abstract

Objective: To develop novel models that predict the occurrence of Delayed Cerebral Ischemia (DCI) and functional outcomes for patients following acute Aneurysmal Subarachnoid Hemorrhage (aSAH).

Methods: A total of 195 cases of aSAH were analyzed retrospectively based on hospitalization data from Taian City Central Hospital, covering the period from September 2019 to January 2023. Patients were categorized into two groups: the DCI group and the non-DCI group, depending on the occurrence of DCI. Additionally, patients were further classified into the Good outcome group and the Poor outcome group based on modified Rankin scale scores assessed three months post-discharge. We compared baseline characteristics among the different groups, including age, gender, smoking history, alcohol consumption, admission blood pressure, Glasgow coma scale score, Hunt-Hess score, aneurysm location, surgical approach, and laboratory test results. This comparison aimed to identify key variables for subsequent multivariable logistic regression analysis. Ultimately, two novel models were shown in nomograms. The Calibration Curve, Decision Curve Analysis curve, and Receiver Operating Characteristic curve were employed to evaluate the performance of these models.

Results: In the model developed to predict DCI following aSAH, hypertension and Hunt-Hess grade emerged as independent risk factors ( P < 0.05). The model demonstrated an Area Under the Curve (AUC) of 79%, with a sensitivity of 85.0% and specificity of 64.5%. In contrast, the model predicting poor functional outcomes after aSAH identified age, Hunt-Hess grade, and ND (neutrophil count × D-dimer levels) as significant influencers on functional outcomes ( P < 0.05). This model achieved an AUC of 83.7%, with a sensitivity of 95.5% and specificity of 61.0%. The calibration curve indicated a strong alignment between the predicted probabilities and the actual outcomes. Additionally, the DCA curve suggested that early intervention could provide substantial benefits based on our findings.

Conclusions: Two independent predictors of DCI following an aSAH are hypertension and the Hunt-Hess grade. Additionally, age, ND, as well as the Hunt-Hess grade, are independent predictors of functional outcomes. The combined predictive nomograms of these factors are greater than that of any single index.