A 90-Day Prognostic Model Based on the Early Brain Injury Indicators after Aneurysmal Subarachnoid Hemorrhage: the TAPS Score

• DOI: 10.1007/s12975-022-01033-4
• Publication Date: 2022-05-14T08:03:01Z
• Authors: Runting Li; Fa Lin; Yu Chen; Junlin Lu; Heze Han; Li Ma; Yahui Zhao; Debin Yan; Ruinan Li; Jun Yang; Shihao He; Zhipeng Li; Haibin Zhang; Kexin Yuan; Ke Wang; Qiang Hao; Xun Ye; Hao Wang; Hongliang Li; Linlin Zhang; Guangzhi Shi; Jianxin Zhou; Yang Zhao; Yukun Zhang; Youxiang Li; Shuo Wang; Xiaolin Chen; Yuanli Zhao
• Keywords: 03 medical and health sciences; 0302 clinical medicine; ROC Curve; Risk Factors; Humans; Prospective Studies; Middle Aged; Subarachnoid Hemorrhage; Prognosis; Retrospective Studies; 3. Good health

This study aimed to establish a new scoring model based on the early brain injury (EBI) indicators to predict the 90-day functional outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). We retrospectively enrolled 825 patients and prospectively enrolled 108 patients with aSAH who underwent surgical clipping or endovascular coiling (derivation cohort = 640; validation cohort = 185; prospective cohort = 108) in our institute. We established a logistic regression model based on independent risk factors associated with 90-day unfavorable outcomes. The discrimination of the prognostic model was assessed by the area under the curve in a receiver operating characteristic curve analysis. The Hosmer-Lemeshow goodness-of-fit test and a calibration plot were used to evaluate the calibration of the prediction model. The developed scoring model named "TAPS" (total score, 0-7 points) included the following admission variables: age > 55 years old, WFNS grade of 4-5, mFS grade of 3-4, Graeb score of 5-12, white blood cell count > 11.28 × 109/L, and surgical clipping. The model showed good discrimination with the area under the curve in the derivation, validation, and prospective cohorts which were 0.816 (p < 0.001, 95%CI = 0.77-0.86), 0.810 (p < 0.001, 95%CI = 0.73-0.90), and 0.803 (p < 0.001, 95%CI = 0.70-0.91), respectively. The model also demonstrated good calibration (Hosmer-Lemeshow goodness-of-fit test: X2 = 1.75, df = 8, p = 0.988). Compared with other predictive models, TAPS is an easy handle tool for predicting the 90-day unfavorable outcomes of aSAH patients, which can help clinicians better understand the concept of EBI and quickly identify those patients at risk of poor prognosis, providing more positive treatment strategies. Trial registration: NCT04785976. Registered 5 March 2021-retrospectively registered, http://www.clinicaltrials.gov .