Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study.
Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study.
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开发和验证一种新型列线图来预测多发性颅内动脉瘤患者的动脉瘤破裂：一项多中心回顾性研究
DOI：
10.1136/svn-2020-000480
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发表时间：
2021-09
影响因子：
5.9
通讯作者：
Wang D
中科院分区：
文献类型：
--
作者：
Feng X;Tong X;Peng F;Niu H;Qi P;Lu J;Zhao Y;Jin W;Wu Z;Zhao Y;Liu A;Wang D
约15%-45%的未破裂颅内动脉瘤患者患有多发性颅内动脉瘤（MIA）。确定哪一个最有可能破裂对于MIA患者的治疗决策极其重要。本研究旨在开发和验证诺模图，以评价MIA患者的动脉瘤破裂风险。来自700例MIA患者的1671例IA被随机分为推导集和验证集。使用多变量logistic回归分析选择预测因子，并在衍生集中构建动脉瘤破裂风险评估的诺模图模型。判别准确性，校准性能和临床实用性的诺模图进行了评估。我们还为158例蛛网膜下腔出血（SAH）患者的亚组开发了一个多变量模型，并将其性能与诺模图模型进行了比较。多变量分析确定了与IA破裂显著相关的7个变量（SAH病史、饮酒、女性、纵横比>1.5、后循环、形状不规则和分叉位置）。基于临床和形态学的MIA（CMB-MIA）列线图模型显示出良好的校准和区分（推导集：曲线下面积（AUC）=0.740验证集：AUC=0.772）。决策曲线分析表明，诺模图是临床上有用的。与列线图模型相比，SAH患者多变量模型的AUC值较低，为0.730。MIA破裂风险的CMB-MIA列线图是第一个在大型多机构队列中开发和验证的。此列线图可用于MIA患者的决策和风险分层。
Approximately 15%–45% of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms (MIAs). Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients. This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients. A total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets. Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set. The discriminative accuracy, calibration performance and clinical usefulness of this nomogram were assessed. We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage (SAH) patients and compared its performance with the nomogram model. Multivariate analyses identified seven variables that were significantly associated with IA rupture (history of SAH, alcohol consumption, female sex, aspect ratio >1.5, posterior circulation, irregular shape and bifurcation location). The clinical and morphological-based MIAs (CMB-MIAs) nomogram model showed good calibration and discrimination (derivation set: area under the curve (AUC)=0.740 validation set: AUC=0.772). Decision curve analysis demonstrated that the nomogram was clinically useful. Compared with the nomogram model, the AUC of multivariate model developed from SAH patients had lower value of 0.730. This CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort. This nomogram could be used in decision-making and risk stratification in MIAs patients.
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影响因子：
4.8
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