Comparison Of Different Models For The Prediction Of Delayed Cerebral Ischemia In Patients With Subarachnoid Hemorrhage After Endovascular Coiling

ObjectivesThe predictive value of different predictive models for the risk of delayed cerebral ischemia(DCI)in patients with aneurysmal subarachnoid hemorrhage(a SAH)after endovascular coiling were compared in order to provide the best tool for clinical decision of treatment.MethodsPatients with a SAH after endovascular coiling were enrolled in the Department of Neurology of our hospital from January 2016 to February 2020.Patients’ basic data,various clinical and imaging scores,endovascular treatment methods and complications were collected,and univariate analysis was performed.The previously published models include The Practical Risk Chart,The VASOGRAGE,the BEHAVIOR score,the EDCI score,and the clinical DCI score.The cohort was used to externally validate the five models.The area under the receiver operating characteristic curve(AUC)and the net reclassification index(NRI)were used to evaluate the predictive value of the models for DCI.Results1.A total of 100 patients were enrolled,of which 23 patients developed DCI(23%).Between the DCI group and the non-DCI group,there was no statistically significant difference in age,gender,history of smoking,history of hypertension,history of diabetes,and history of vascular disease(p<0.05).2.The AUC of the five models were all less than 0.65.The AUC value of the BEHAVIOR score is less than 0.5.The AUC value of The Practical Risk Chart is the highest(AUC=0.643,95%CI=0.522-0.764),followed by the EDCI score,VASOGRAGE,and the clinical DCI score.3.Excluding the BEHAVIOR score,NRI analysis shows that compared with VASOGRAGE,the EDCI score,and the clinical DCI score,the proportion of The Practical Risk Chart in predicting the correct stratification of DCI risk has increased(12.5%,9%,18.5%,respectively).ConclusionsThe Practical Risk Chart may be the best tool for predicting the risk of delayed cerebral ischemia in patients with a SAH after endovascular coiling at present.However,the applicability of the clinical prediction model at different times and regions still needs further research.