创伤性蛛网膜下腔出血并发分流依赖性脑积水危险因素分析及列线图预测模型的构建

Risk factors for shunt dependent hydrocephalus in patients with traumatic subarachnoid hemorrhage and establishment of their nomogram prediction model

目的探讨创伤性蛛网膜下腔出血(tSAH)患者发生分流依赖性脑积水(SDHC)的危险因素并构建列线图预测模型。方法选择南京医科大学第一附属医院神经外科自2018年2月至2022年2月收治的269例tSAH患者, 出院后均随访3个月, 随访期间并发SDHC 51例, 未并发SDHC 218例。比较并发SDHC组和未并发SDHC组患者的临床资料, 采用多因素Logistic回归分析确定tSAH患者并发SDHC的独立影响因素, 根据多因素Logistic回归分析结果构建预测tSAH患者并发SDHC的列线图模型, 使用一致性系数(C-index)和校准曲线评估列线图模型的预测效能和符合度。结果与未并发SDHC组比较, 并发SDHC组患者的入院格拉斯哥昏迷量表(GCS)评分较低, 合并脑疝、tSAH范围弥散、tSAH厚度≥5 mm、脑室内积血、中线偏移>12 mm、行去骨瓣减压术及出院时有硬膜外积液者所占比例较高, 差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示入院GCS评分13~15分(OR=0.134, 95%CI:0.024~0.740, P=0.021)、tSAH范围弥散(OR=4.391, 95%CI:1.680~11.475, P=0.003)、tSAH厚度≥5 mm(OR=4.114, 95%CI:1.689~10.018, P=0.002)、去骨瓣减压术(OR=3.283, 95%CI:1.278~8.433, P=0.014)及出现硬膜外积液(OR=3.302, 95%CI:1.137~9.593, P=0.028)为tSAH并发SDHC的独立影响因素。基于上述因素建立预测tSAH并发SDHC风险的列线图模型, C-index(0.877)和校准曲线显示该预测模型的准确度较高, 符合度好。结论入院GCS评分低、tSAH范围弥散、tSAH厚度≥5 mm、行骨瓣减压术及合并硬膜外积液的tSAH患者易并发SDHC, 基于上述变量构建的列线图模型预测tSAH并发SDHC风险的效能较高。

Objective To explore the risk factors for shunt dependent hydrocephalus(SDHC)in patients with traumatic subarachnoid hemorrhage(tSAH)and establish their risk nomogram model.Methods Two hundred and sixty-nine patients with tSAH,admitted to our hospital from February 2018 to February 2022,were chosen in our study.All patients were followed up for 3 months after discharge;51 patients were complicated with SDHC and 218 patients were not complicated with SDHC.The clinical data of patients with and without SDHC were compared.Multivariate Logistic regression analysis was used to determine the independent influencing factors for SDHC in tSAH patients;according to the results of multivariate Logistic regression analysis,a nomogram model was constructed to predict SDHC in tSAH patients;and the consistency index(C-index)and calibration curve were used to evaluate the predictive performance and compliance of the nomogram model.Results As compared with patients without SDHC group,patients with SDHC had significantly lower Glasgow Coma Scale(GCS)scores on admission,and significantly higher proportions of patients with cerebral hernia,diffuse tSAH,tSAH thickness≥5 mm,intraventricular hemorrhage,midline shift>12 mm,and epidural effusion at discharge,and patients accepted decompressive craniectomy(P<0.05).Multivariate Logistic regression analysis showed that GCS scores of 13-15(OR=0.134,95%CI:0.024-0.740,P=0.021),diffuse tSAH(OR=4.391,95%CI:1.680-11.475,P=0.003),tSAH thickness≥5 mm(OR=4.114,95%CI:1.689-10.018,P=0.002),decompressive craniectomy(OR=3.283,95%CI:1.278-8.433,P=0.014)and epidural hydrops(OR=3.302,95%CI:1.137-9.593,P=0.028)were independent influencing factors for SDHC in tSAH patients.A nomogram model established based on the above 5 influencing factors showed high predictive accuracy with C-index of 0.877.Conclusion The tSAH patients with low GCS scores at admission,diffuse tSAH,tSAH thickness≥5 mm,and epidural effusion,and patients accepted decompressive craniectomy are prone to have SDHC;the nomogram model based on the above variables has a high efficiency in predicting the risk of tSAH complicated with SDHC.