Establishment and multicenter external validation of a risk prediction model for de novo intracranial aneurysms based on a systematic review and meta-analysis of 19 cohorts

作者全名：Tan, Jiahe; Song, Rui; Su, Jun; Wu, Hongyu; Fu, Wenqiao; Ma, Yinrui; He, Zhaohui

作者地址：[Tan, Jiahe; Su, Jun; Fu, Wenqiao; Ma, Yinrui; He, Zhaohui] Chongqing Med Univ, Affiliated Hosp 1, Dept Neurosurg, Chongqing, Peoples R China; [Tan, Jiahe] Chongqing Med Univ, Affiliated Hosp 2, Dept Neurosurg, Chongqing, Peoples R China; [Song, Rui] Chongqing Med Univ, Affiliated Hosp 2, Dept Infect Dis, Chongqing, Peoples R China; [Wu, Hongyu] Chongqing Med Univ, Affiliated Hosp 2, Dept Hepatobiliary Surg, Chongqing, Peoples R China

通信作者：He, ZH (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Chongqing, Peoples R China.

来源：JOURNAL OF NEUROSURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001204676200003

JCR分区：Q1

影响因子：3.5

年份：2024

卷号：140

期号：3

开始页：783

结束页：791

文献类型：Article

关键词：de novo; intracranial aneurysm; risk factor; prediction model; cohort study; vascular disorders

摘要：OBJECTIVE A de novo intracranial aneurysm (IA) is a second, new IA that develops in patients with IAs distant from where the initial IA was detected. This study aimed to identify risk factors for de novo IA formation and establish and externally validate a multicenter risk prediction model for de novo IAs. METHODS A systematic review and meta-analysis of existing de novo IA cohorts was conducted to form the derivation cohort. The risk ratios and 95% CIs of each risk factor were calculated. In addition, risk scores included in the model were calculated based on the statistically significant risk factors with their weightings. Then the model was validated in a multicenter external cohort of Chinese patients, and receiver operating characteristic and calibration curves, decision curve analysis, and Kaplan-Meier curves were used to evaluate the model. RESULTS Nineteen studies with 9351 patients, of whom 304 patients (3.25%) developed de novo IAs, were included in the derivation cohort. These patients developed de novo IAs at 2.5-18.5 years during a total follow-up of 3.3-18.8 years. The statistically significant risk factors were age < 60 years, female sex, smoking history, family history of IAs, multiple IAs at initial diagnosis, and initial IAs in the middle cerebral artery, with risk scores of 4, 5, 2, 6, 3, and 3, respectively. Then, a multicenter external cohort comprising 776 patients, of whom 45 patients (5.80%) developed de novo IAs, was included in the validation cohort. De novo IAs formed in these patients at a mean of 5.25 years during a mean follow-up of 6.19 years. The area under the curve of the model was 0.804, with a sensitivity of 0.667 and specificity of 0.900, at a cutoff value of 13. The calibration curve, decision curve analysis, and Kaplan-Meier curves also indicated good performance of the model. CONCLUSIONS This prediction model is a convenient and intuitive tool for identifying high-risk patients with de novo IAs. Reasonable use of the model can not only aid in clinical decision-making but also play a positive role in the prevention of aneurysmal subarachnoid hemorrhage to a certain extent. Systematic review registration no.: CRD42022349257 (www.crd.york.ac.uk/prospero)

基金机构：National Natural Science Foundation of China [NSFC 81870927]; Natural Science Foundation Project of Chongqing Science and Technology Commission [CSTB2023NSCQ-MSX0112]

基金资助正文：<B>Acknowledgments</B> We thank Dr. Jiewen Deng for guidance with the statistics during the research. This study was supported by the National Natural Science Foundation of China (NSFC 81870927) and the Natural Science Foundation Project of Chongqing Science and Technology Commission (CSTB2023NSCQ-MSX0112) .