Development of a Complication- and Treatment-Aware Prediction Model for Favorable Functional Outcome in Aneurysmal Subarachnoid Hemorrhage Based on Machine Learning.

Autor:	Maldaner N; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.; Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Zeitlberger AM; Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Sosnova M; Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Goldberg J; Department of Neurosurgery, University Hospital Bern, Bern, Switzerland., Fung C; Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.; Department of Neurosurgery, Medical Center - University of Freiburg, Germany., Bervini D; Department of Neurosurgery, University Hospital Bern, Bern, Switzerland., May A; Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland., Bijlenga P; Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland., Schaller K; Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland., Roethlisberger M; Department of Neurosurgery, Basel University Hospital, Basel, Switzerland., Rychen J; Department of Neurosurgery, Basel University Hospital, Basel, Switzerland., Zumofen DW; Department of Neurosurgery, Neurology, and Radiology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, NY, USA., D'Alonzo D; Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland., Marbacher S; Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland., Fandino J; Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland., Daniel RT; Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland., Burkhardt JK; Department of Neurosurgery, Baylor College of Medicine, Houston, USA., Chiappini A; Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland., Robert T; Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland., Schatlo B; Department of Neurosurgery, University Hospital Göttingen, Germany., Schmid J; Dynelytics, Zurich, Switzerland., Maduri R; Neurosurgery, Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland., Staartjes VE; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland., Seule MA; Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Weyerbrock A; Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Serra C; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland., Stienen MN; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland., Bozinov O; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.; Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Regli L; Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2021 Jan 13; Vol. 88 (2), pp. E150-E157.
DOI:	10.1093/neuros/nyaa401
Abstrakt:	Background: Current prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission. Objective: To develop and validate a complication- and treatment-aware outcome prediction tool in aSAH. Methods: This cohort study included data from an ongoing prospective nationwide multicenter registry on all aSAH patients in Switzerland (Swiss SOS [Swiss Study on aSAH]; 2009-2015). We trained supervised machine learning algorithms to predict a binary outcome at discharge (modified Rankin scale [mRS] ≤ 3: favorable; mRS 4-6: unfavorable). Clinical and radiological variables on admission ("Early" Model) as well as additional variables regarding secondary complications and disease management ("Late" Model) were used. Performance of both models was assessed by classification performance metrics on an out-of-sample test dataset. Results: Favorable functional outcome at discharge was observed in 1156 (62.0%) of 1866 patients. Both models scored a high accuracy of 75% to 76% on the test set. The "Late" outcome model outperformed the "Early" model with an area under the receiver operator characteristics curve (AUC) of 0.85 vs 0.79, corresponding to a specificity of 0.81 vs 0.70 and a sensitivity of 0.71 vs 0.79, respectively. Conclusion: Both machine learning models show good discrimination and calibration confirmed on application to an internal test dataset of patients with a wide range of disease severity treated in different institutions within a nationwide registry. Our study indicates that the inclusion of variables reflecting the clinical course of the patient may lead to outcome predictions with superior predictive power compared to a model based on admission data only. (Copyright © 2020 by the Congress of Neurological Surgeons.)
Databáze:	MEDLINE
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