克拉生坦时代动脉瘤性蛛网膜下腔出血的预后因素:一项使用多变量分析和机器学习模型的多中心研究。

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Shinsuke Muraoka, Takashi Izumi, Kazuki Ishii, Issei Takeuchi, Masahiro Nishihori, Shunsaku Goto, Fumiaki Kanamori, Kenji Uda, Yusuke Sakamoto, Kinya Yokoyama, Kazuki Nishida, Basile Chretien, Ryuta Saito
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引用次数: 0

摘要

背景:控制迟发性脑缺血(DCI)是改善动脉瘤性蛛网膜下腔出血(aSAH)患者预后的关键。本研究旨在确定日本aSAH患者的预后因素。方法:于2021年4月至2024年3月进行多中心、回顾性、观察性队列研究。患者在发病后48小时内对破裂的动脉瘤进行手术修复,术后给予多种药物治疗,包括克唑森坦和法舒地尔,以防止脑血管痉挛。主要结局是患者预后良好的比例,定义为出院时修改的Rankin量表评分0到2分。采用多元逻辑回归和逐步模型选择来确定预后因素。SHapley加性解释(SHAP)分析用于可视化预测因子的相对重要性及其对结果的影响。结果:506例患者(平均年龄63.5岁,女性66.6%)中,53.0%的患者获得了良好的预后。在多变量分析中,使用克唑森坦治疗与1.84倍的有利结果相关(p = 0.021),当使用克唑森坦治疗无体液潴留并发症时增加到1.97倍(p = 0.010)。SHAP分析进一步强调了每个因素对预后的影响,确定较低的WFNS分级、较低的Fisher分级、较年轻、使用克唑生坦、西洛他唑和他汀类药物是预后良好的重要预测因素。结论:aSAH发病时的临床状态和年龄是不可控因素;因此,改善预后需要有针对性地预防DCI和有效地处理脑水肿。给予克唑生坦、西洛他唑和他汀类药物等治疗可能有助于获得良好的结果。临床试验号:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic factors in aneurysmal subarachnoid hemorrhage during the clazosentan era: a multicenter study using multivariate analyses and machine learning model.

Background: Controlling delayed cerebral ischemia (DCI) is crucial for improving the prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to identify prognostic factors in patients with aSAH in Japan.

Methods: A multicenter, retrospective, observational cohort study was conducted from April 2021 to March 2024. Patients underwent surgical repair of ruptured aneurysms within 48 h of onset, followed by postoperative treatment with multiple drugs, including clazosentan and fasudil, to prevent cerebral vasospasm. The primary outcome was the proportion of patients with a good outcome, defined as a modified Rankin Scale score of 0 to 2 at discharge. Multivariate logistic regression and stepwise model selection were applied to identify prognostic factors. SHapley Additive exPlanations (SHAP) analysis was used to visualize the relative importance of predictors and their impact on outcomes.

Results: Among 506 patients (mean age 63.5 years, 66.6% female), 53.0% achieved a favorable outcome. In multivariate analysis, treatment with clazosentan was associated with 1.84 times higher odds of a favorable outcome (p = 0.021), increasing to 1.97 when clazosentan was administered without fluid retention complications (p = 0.010). SHAP analysis further highlighted the impact of each factor on prognosis, identifying a lower WFNS grade, lower Fisher grade, younger age, clazosentan, cilostazol, and statin use as significant predictors of favorable outcomes.

Conclusion: Clinical status at aSAH onset and age are uncontrollable factors; therefore, improving prognosis requires targeted prevention of DCI and effective management of brain edema. The administration of therapies such as clazosentan, cilostazol, and statins may contribute to favorable outcomes.

Clinical trial number: Not applicable.

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来源期刊
Neurosurgical Review
Neurosurgical Review 医学-临床神经学
CiteScore
5.60
自引率
7.10%
发文量
191
审稿时长
6-12 weeks
期刊介绍: The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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