JNNP:动脉瘤性蛛网膜下腔出血患者年龄与不良预后之间非线性关系的可视化研究

2021-06-21 MedSci原创 MedSci原创

血栓切除术在大血管急性缺血性中风(LVOS)晚期表现和清醒期中风中的益处现已得到证实。具有里程碑意义的DAWN(使用Trevo进行神经干预的唤醒和晚期中风分类的临床不匹配)和DEFUSE 3(缺血性中

据报道,动脉瘤性蛛网膜下腔出血(SAH)的病死率约为35%,在老年人中仍然很高。尽管已经发表了关于动脉瘤性SAH预后的预测模型,目前还没有可视化的工具来辅助临床决策,并通过图形化的方式来告知患者及其家属年龄与不良预后之间的非线性关系。发达国家的人口老龄化将给未来社会带来前所未有的负担。根据经济合作与发展组织的数据,日本是世界上预期寿命最高的国家。因此,日本是进行高龄影响研究的合适国家。

高龄和初始神经状态差对动脉瘤性蛛网膜下腔出血(SAH)患者通过外科夹闭或血管内缠绕治疗结果的不利影响已被记录在案。临床阈值年龄为70或75岁,具体取决于报告。在某些临床领域,年龄和预后之间的相关性是非线性的。然而,迄今为止,还没有关于动脉瘤性蛛网膜下腔出血这种非线性相关性的详细分析和可视化报道。因此,有必要根据动脉瘤性蛛网膜下腔出血患者的初始神经状态进行研究,以作为观察这种相关性的参考。在这项研究中,在日本进行了全国性的临床注册,以观察年龄与接受根治性治疗的动脉瘤性蛛网膜下腔出血患者出院时不良结局之间的非线性关系,同时根据患者最初的神经状态调整其他协变量并解决异质性。

SAH相关信息包括年龄、性别、病史(高血压、糖尿病和中风)、动脉瘤类型、破裂脑动脉瘤的位置和大小、SAH发病日期、入院日期、首次入院时根据世界神经学会联合会(WFNS)评分的神经状态,入院时Fisher-CT分级22分,治疗(手术夹闭、血管内栓塞等)23分,起病前及出院时改良Rankin评分(mRS)24分,住院天数(天)。脑动脉瘤破裂的部位分为:前交通动脉、大脑中动脉、颈内动脉后交通动脉和颈内动脉脉络膜前动脉相关动脉、其他颈内动脉、大脑前动脉和椎基底动脉。动脉瘤的最大直径分类如下:<6 mm,6-14 mm,15-23 mm和≥24mm。

Figure 1

患者群体

为了计算发病和治疗之间的天数,假设患者在入院后立即接受治疗。这反映了参与JSDB的医院的常规做法,很少有例外。WFNS分级、Fisher-CT分级、脑动脉瘤的位置和大小以及mRS由主治神经外科医生确定,并由各机构神经外科主任批准。我们从JSDB中提取了2000年1月至2017年12月期间发生动脉瘤性蛛网膜下腔出血的患者数据。在10721例SAH患者中,4149例被诊断为囊性脑动脉瘤破裂并通过外科夹闭或血管内栓塞治疗的患者被纳入分析。具体来说,为了呈现患者特征,将接受两种治疗的患者分为10年一组。

总共有4149名患者被纳入分析。在研究队列中,36%的患者预后不佳(mRS评分)≥3) 出院时,62%的患者有轻度WFNS分级(I级和II级)。选择的每个节点可能分裂的变量数和最小节点大小分别为4个和50个。模型的精密度、召回(敏感度)、特异度和准确度分别为0.722、0.651、0.860和0.785。WFNS分级和年龄是预测预后的最大和第二大变量,年龄的变量重要性是WFNS的0.57倍。WFNS分级和年龄依次为Fisher-CT分级和动脉瘤大小,其变异重要性分别为WFNS的0.17倍和0.10倍。

Figure 2

变量重要性计算为随机森林模型预测不良结果

本研究详细观察了动脉瘤性蛛网膜下腔出血患者的年龄与不良预后之间的非线性关系。在动脉瘤性蛛网膜下腔出血患者中,除年龄外,还有几个因素影响预后,包括入院时WFNS分级、22 Fisher CT分级、23个动脉瘤大小和治疗方法。我们的随机森林分析显示,出院时不良结局的最强因素是入院时WFNS分级和患者年龄。我们采用了两种方法,即修正条件图和部分相关图。第一种方法的优点是显示了预测模型的95%置信区间,但不能充分反映研究人群中协变量的分布,第二种方法考虑到研究人群中协变量的分布,允许描述年龄与不良结局之间的相关性,但没有显示预测的可信度。因此,考虑到临床风险与主要自变量的相关性,这两种方法可以作为检验临床风险的补充。治疗组之间年龄和不良结局的相关性相似 ,因此本文对整个队列进行了相似的分析 。

本文研究结果可用于标准化和提高治疗质量,以及使动脉瘤性蛛网膜下腔出血患者及其家属参与治疗管理。

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  4. [GetPortalCommentsPageByObjectIdResponse(id=1654510, encodeId=95e3165451028, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Thu Dec 02 00:44:53 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1942865, encodeId=1cdd194286516, content=<a href='/topic/show?id=5244385233f' target=_blank style='color:#2F92EE;'>#可视化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38523, encryptionId=5244385233f, topicName=可视化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, 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  5. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/c5865be62d9f415c8e1d675404a5fef4/50aaae8df8554eeaaf2cbf14ac782da5.jpg, createdBy=af1f5531418, createdName=吴渺渺, createdTime=Tue Jun 22 17:26:33 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975788, encodeId=d43b9e57886e, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb1f5531082, createdName=ms7000000277652389, createdTime=Tue Jun 22 12:34:54 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975763, encodeId=1ea09e576385, content=厉害了, beContent=null, objectType=article, channel=null, 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objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2f125530821, createdName=acd17787, createdTime=Tue Jun 22 00:08:59 CST 2021, time=2021-06-22, status=1, ipAttribution=)]
    2021-06-22 1211c54em14(暂无昵称)

    学习了

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2f125530821, createdName=acd17787, createdTime=Tue Jun 22 00:08:59 CST 2021, time=2021-06-22, status=1, ipAttribution=)]
    2021-06-22 吴渺渺

    学习👏🏻👏🏻

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1654510, encodeId=95e3165451028, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Thu Dec 02 00:44:53 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1942865, encodeId=1cdd194286516, content=<a href='/topic/show?id=5244385233f' target=_blank style='color:#2F92EE;'>#可视化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38523, encryptionId=5244385233f, topicName=可视化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Tue May 24 04:44:53 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336437, encodeId=504d133643e8f, content=<a href='/topic/show?id=071820530c5' target=_blank style='color:#2F92EE;'>#不良预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20530, encryptionId=071820530c5, topicName=不良预后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Wed Jun 23 12:44:53 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337812, encodeId=f87b133e812ac, content=<a href='/topic/show?id=376c332e497' target=_blank style='color:#2F92EE;'>#动脉瘤性蛛网膜下腔出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33274, encryptionId=376c332e497, topicName=动脉瘤性蛛网膜下腔出血)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Wed Jun 23 12:44:53 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975936, encodeId=2f029e593641, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60182229007, createdName=1211c54em14(暂无昵称), createdTime=Tue Jun 22 21:35:12 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975854, encodeId=66339e58545a, content=学习👏🏻👏🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/c5865be62d9f415c8e1d675404a5fef4/50aaae8df8554eeaaf2cbf14ac782da5.jpg, createdBy=af1f5531418, createdName=吴渺渺, createdTime=Tue Jun 22 17:26:33 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975788, encodeId=d43b9e57886e, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb1f5531082, createdName=ms7000000277652389, createdTime=Tue Jun 22 12:34:54 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975763, encodeId=1ea09e576385, content=厉害了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/0ff31a8b553f430faa1402b6fcf742ef/c74d11523587446c84b144b663ec49b0.jpg, createdBy=0dcf5173856, createdName=146e13a2m23暂无昵称, createdTime=Tue Jun 22 11:10:13 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975657, encodeId=3e8a9e5657e9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/bbcb044a251548d2814f50c1842b6055/8c2fdcca23e746048e025b3d12e68743.jpg, createdBy=3e5c5530839, createdName=徐旨绪, createdTime=Tue Jun 22 01:42:21 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975639, encodeId=e18b9e56399f, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2f125530821, createdName=acd17787, createdTime=Tue Jun 22 00:08:59 CST 2021, time=2021-06-22, status=1, ipAttribution=)]
    2021-06-22 ms7000000277652389

    #学习#学习

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1654510, encodeId=95e3165451028, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Thu Dec 02 00:44:53 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1942865, encodeId=1cdd194286516, content=<a href='/topic/show?id=5244385233f' target=_blank style='color:#2F92EE;'>#可视化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38523, encryptionId=5244385233f, topicName=可视化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/c5865be62d9f415c8e1d675404a5fef4/50aaae8df8554eeaaf2cbf14ac782da5.jpg, createdBy=af1f5531418, createdName=吴渺渺, createdTime=Tue Jun 22 17:26:33 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975788, encodeId=d43b9e57886e, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb1f5531082, createdName=ms7000000277652389, createdTime=Tue Jun 22 12:34:54 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975763, encodeId=1ea09e576385, content=厉害了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/0ff31a8b553f430faa1402b6fcf742ef/c74d11523587446c84b144b663ec49b0.jpg, createdBy=0dcf5173856, createdName=146e13a2m23暂无昵称, createdTime=Tue Jun 22 11:10:13 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975657, encodeId=3e8a9e5657e9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/bbcb044a251548d2814f50c1842b6055/8c2fdcca23e746048e025b3d12e68743.jpg, createdBy=3e5c5530839, createdName=徐旨绪, createdTime=Tue Jun 22 01:42:21 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975639, encodeId=e18b9e56399f, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2f125530821, createdName=acd17787, createdTime=Tue Jun 22 00:08:59 CST 2021, time=2021-06-22, status=1, ipAttribution=)]
    2021-06-22 146e13a2m23暂无昵称

    厉害了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1654510, encodeId=95e3165451028, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Thu Dec 02 00:44:53 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1942865, encodeId=1cdd194286516, content=<a href='/topic/show?id=5244385233f' target=_blank style='color:#2F92EE;'>#可视化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38523, encryptionId=5244385233f, topicName=可视化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/c5865be62d9f415c8e1d675404a5fef4/50aaae8df8554eeaaf2cbf14ac782da5.jpg, createdBy=af1f5531418, createdName=吴渺渺, createdTime=Tue Jun 22 17:26:33 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975788, encodeId=d43b9e57886e, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb1f5531082, createdName=ms7000000277652389, createdTime=Tue Jun 22 12:34:54 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975763, encodeId=1ea09e576385, content=厉害了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/0ff31a8b553f430faa1402b6fcf742ef/c74d11523587446c84b144b663ec49b0.jpg, createdBy=0dcf5173856, createdName=146e13a2m23暂无昵称, createdTime=Tue Jun 22 11:10:13 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975657, encodeId=3e8a9e5657e9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/bbcb044a251548d2814f50c1842b6055/8c2fdcca23e746048e025b3d12e68743.jpg, createdBy=3e5c5530839, createdName=徐旨绪, createdTime=Tue Jun 22 01:42:21 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975639, encodeId=e18b9e56399f, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2f125530821, createdName=acd17787, createdTime=Tue Jun 22 00:08:59 CST 2021, time=2021-06-22, status=1, ipAttribution=)]
    2021-06-22 徐旨绪

    学习

    0

  10. 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level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/0ff31a8b553f430faa1402b6fcf742ef/c74d11523587446c84b144b663ec49b0.jpg, createdBy=0dcf5173856, createdName=146e13a2m23暂无昵称, createdTime=Tue Jun 22 11:10:13 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975657, encodeId=3e8a9e5657e9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210622/bbcb044a251548d2814f50c1842b6055/8c2fdcca23e746048e025b3d12e68743.jpg, createdBy=3e5c5530839, createdName=徐旨绪, createdTime=Tue Jun 22 01:42:21 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975639, encodeId=e18b9e56399f, content=写的很好, beContent=null, 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    2021-06-22 acd17787

    写的很好

    0

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