Development and validation of a prognostic computed tomography scoring model for functional outcomes in patients with large hemispheric infarction following decompressive craniectomy

作者全名："Zhao, Yutong; Tang, Yuguang; Xie, Zongyi"

作者地址："[Zhao, Yutong; Tang, Yuguang; Xie, Zongyi] Chongqing Med Univ, Affiliated Hosp 2, Dept Neurosurg, Chongqing, Peoples R China"

通信作者："Xie, ZY (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Neurosurg, Chongqing, Peoples R China."

来源：FRONTIERS IN NEUROLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001158156000001

JCR分区：Q2

影响因子：3.4

年份：2024

卷号：15

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：large hemispheric infarction; decompressive Craniectomy; prediction model; functional outcome; cohort study

摘要："Background: There is no established prognostic scoring system developed for patients with large hemispheric infarction (LHI) following decompressive craniectomy (DC) based on imaging characteristics. The present study aimed to develop and validate a new computed tomography scoring model to assess the 6-month risk of poor functional outcomes (modified-Rankin scale [mRS] score of 4-6) in patients with LHI receiving DC. Methods: This retrospective cohort study included patients at two tertiary stroke centers. A prediction model was developed based on a multivariable logistic regression. The final risk factors included the ASPECTS (Alberta Stroke Program Early Computed Tomography Score), longitudinal fissure cistern, Sylvian fissure cistern, and additional vascular territory involvement. 1,000 bootstrap resamples and temporal validation were implemented as validations for the scoring system. Results: Of the 100 individuals included in the development cohort, 71 had poor functional outcomes. The scoring model presented excellent discrimination and calibration with C-index = 0.87 for the development cohort, and C-index = 0.83 for the temporal validation cohort with non-significant Hosmer-Lemeshow goodness-of-fit test. The scoring model also showed an improved AUC compared to the ASPECTS. For each point in the score model, the adjusted risk of poor functional outcomes increase by 47.8% (OR = 1.48, p < 0.001). The scores were inversely correlated with MAP (mean arterial pressure, paired t-test, p = 0.0015) and CPP (cerebral perfusion pressure, rho = -0.17, p = 0.04). Conclusion: In patients with LHI following DC, the score system is an excellent predictor of poor functional outcomes and is associated with CPP and MAP, which might be worth considering in clinical settings after further external validation."

基金机构：Senior Medical Talents Program of Chongqing for Young and Middle-aged

基金资助正文：No Statement Available