Prognostic Factors in Aneurysmal Subarachnoid Hemorrhage: Pooled Analyses of Individual Patient Data and Development of Novel Risk Scores in Large Cohorts of International Patients
Notice bibliographique
Résumé
Primary studies reporting prognostic associations in aneurysmal subarachnoid hemorrhage (SAH) are often insufficiently powered, use data of limited representativeness and scarcely examine the added value of prognostic factors above those of other known factors. Hence, considerable knowledge gaps and conflicting results exist in the literature on the nature and extent of prognostic associations in SAH. Prognostic factors have been combined to develop prediction models and risk scores for early outcome prediction after SAH. None is routinely applied in clinical or research settings; some major constraints relate to lack of evidence on the predictive accuracy, reliability and generalizability of reported risk scores. The global aim of this research was to address these challenges and contribute to improved understanding of prognostic associations in SAH by analysing large cohorts of SAH patients reflecting a broad spectrum of settings. Pooled analyses of patient-level data from multiple randomized clinical trials and prospective hospital registries involving 10963 patients demonstrated a strong prognostic effect of admission neurologic status on 3-month outcome according to Glasgow outcome score. Age had a moderate effect on outcome; premorbid hypertension and subarachnoid clot burden on the Fisher scale were weak predictors of outcome. Patient's sex had no independent predictive value. Prognostic effect of aneurysm size and location depended on treatment modality. Novel prognostic scores were developed combining these predictors for early prediction of mortality and unfavorable outcomes at 3 months, and demonstrated adequate performance at bootstrap (AUC: 0.77 - 0.83) and at cross validation. Using 2 nationally representative administrative datasets, socioeconomic status and race/ethnicity were explored as latent prognostic factors in SAH. Multinomial logistic regression analysis demonstrated socioeconomic status, measured as neighborhood income status, was associated with inpatient mortality risk after admission for SAH. The extent of the association could be related to health care system under which treatment was provided. Race/ethnicity was independently associated with inpatient mortality. Patients of Hispanic ethnicity had the best outcomes and Asia/Pacific Islanders experienced the worst outcomes during the inpatient course. This research has provided higher level evidence than prior studies on studied prognostic factors and reliable tools for early prediction of outcome after hospitalization for SAH.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».