Construction of a nomogram to predict postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage based on the Dryad database and its validation

doi:10.3969/j.issn.1004-583X.2025.04.003

Abstract

Abstract:

Objective To explore the influencing factors for postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH), and to construct a nomogram and validate its performance. Methods A total of 236 aSAH patients with clinical data recorded in the Dryad database from January 2010 to December 2015 were collected. They were randomly divided into the training set (n=166) and validation set (n=70) at a ratio of 7∶3. Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors for postoperative hydrocephalus in aSAH patients, and a nomogram was therefore constructed. The receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the test efficiency of the nomogram. Results The results of multivariate logistic regression analysis showed that age≥60 years (HR=1.170, P=0.032), craniotomy clipping (HR=2.018, P=0.041), ventricular hemorrhage (HR=1.439, P=0.032), rebleeding (HR=1.095, P=0.001), delayed cerebral ischemia (HR=1.318, P=0.038), and prolonged mechanical ventilation time (HR=3.112, P=0.012) were independent risk factors for postoperative hydrocephalus in aSAH patients (all P<0.05). Based on this, a nomogram was constructed to predict the risk of postoperative hydrocephalus in aSAH patients. The area under the curve (AUC) was 0.757 in the training set, and 0.667 in the validation set. The calibration curve fitted well with the ideal curve, and the DCA curve showed good clinical net benefits within the threshold probability range of 0.20-0.80. Conclusion Age≥60 years, craniotomy clipping, ventricular hemorrhage, rebleeding, delayed cerebral ischemia, and prolonged mechanical ventilation time are independent risk factors for postoperative hydrocephalus in aSAH patients. The nomogram can be used to predict the incidence of postoperative hydrocephalus in aSAH patients, providing a reference for clinicians to select appropriate individualized treatment plans.

Key words: subarachnoid hemorrhage, hydrocephalus, influencing factors, nomogram

CLC Number:

R743.35

Wang Zhuangzhuang, Ren Huan, Liu Yanting, Tian Chunlei. Construction of a nomogram to predict postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage based on the Dryad database and its validation[J]. Clinical Focus, 2025, 40(4): 313-319.

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URL: https://lchc.magtechjournal.com/EN/10.3969/j.issn.1004-583X.2025.04.003

https://lchc.magtechjournal.com/EN/Y2025/V40/I4/313

Figures/Tables 6

Tab. 1 Clinical features of training set groups

项目	脑积水组(n=115)	非脑积水组(n=51)	$t$ /χ²值	P值
年龄(岁)	55.13±13.09	54.41±12.98	0.32	0.744
女性[例(%)]	70(60.87)	33(64.71)	0.22	0.730
高血压[例(%)]	72(62.61)	34(66.67)	0.29	0.861
吸烟[例(%)]	36(31.30)	18(35.29)	0.25	0.720
酗酒[例(%)]	12(10.43)	5(9.80)	0.02	0.902
糖尿病[例(%)]	5(4.35)	2(3.92)	0.90	0.016
心血管疾病[例(%)]	23(20.00)	8(15.69)	0.43	0.667
SAPSⅡ评分(分)	42.21±10.91	42.33±14.71	9.47	0.002
脑出血[例(%)]	62(53.91)	21(41.18)	2.29	0.178
早期脑损伤[例(%)]	84(73.04)	40(78.43)	0.54	0.461
DCI[例(%)]	39(33.91)	8(15.68)	5.78	0.016
再出血[例(%)]	21(18.26)	5(9.80)	1.91	0.167
血管痉挛[例(%)]	92(80.00)	21(41.18)	1.23	0.035
机械通气时间(d)	20.37±1.51	13.51±2.43	2.45	0.015
住院时间(d)	27.64±1.91	18.65±3.51	2.43	0.016
动脉瘤位置[例(%)]
前循环	104(90.43)	41(80.39)
后循环	9(7.82)	10(19.61)	1.24	<0.001
其他	1(1.75)	0(0.00)
GCS评分[例(%)]
≤5分	113(98.26)	50(98.04)
6~8分	2(1.74)	0(0.00)	3.14	0.208
≥9分	0(0)	1(1.96)
Fisher评分[例(%)]
Ⅰ	1(0.87)	0(0.00)
Ⅱ	2(1.73)	2(3.92)	1.44	0.696
Ⅲ	21(18.26)	11(21.57)
Ⅳ	91(79.13)	38(74.51)
手术方式[例(%)]
介入栓塞开颅夹闭	80(69.57) 35(30.43)	32(62.75) 19(37.25)	21.36	<0.001

Tab. 1 Clinical features of training set groups

项目	脑积水组(n=115)	非脑积水组(n=51)	$t$ /χ²值	P值
年龄(岁)	55.13±13.09	54.41±12.98	0.32	0.744
女性[例(%)]	70(60.87)	33(64.71)	0.22	0.730
高血压[例(%)]	72(62.61)	34(66.67)	0.29	0.861
吸烟[例(%)]	36(31.30)	18(35.29)	0.25	0.720
酗酒[例(%)]	12(10.43)	5(9.80)	0.02	0.902
糖尿病[例(%)]	5(4.35)	2(3.92)	0.90	0.016
心血管疾病[例(%)]	23(20.00)	8(15.69)	0.43	0.667
SAPSⅡ评分(分)	42.21±10.91	42.33±14.71	9.47	0.002
脑出血[例(%)]	62(53.91)	21(41.18)	2.29	0.178
早期脑损伤[例(%)]	84(73.04)	40(78.43)	0.54	0.461
DCI[例(%)]	39(33.91)	8(15.68)	5.78	0.016
再出血[例(%)]	21(18.26)	5(9.80)	1.91	0.167
血管痉挛[例(%)]	92(80.00)	21(41.18)	1.23	0.035
机械通气时间(d)	20.37±1.51	13.51±2.43	2.45	0.015
住院时间(d)	27.64±1.91	18.65±3.51	2.43	0.016
动脉瘤位置[例(%)]
前循环	104(90.43)	41(80.39)
后循环	9(7.82)	10(19.61)	1.24	<0.001
其他	1(1.75)	0(0.00)
GCS评分[例(%)]
≤5分	113(98.26)	50(98.04)
6~8分	2(1.74)	0(0.00)	3.14	0.208
≥9分	0(0)	1(1.96)
Fisher评分[例(%)]
Ⅰ	1(0.87)	0(0.00)
Ⅱ	2(1.73)	2(3.92)	1.44	0.696
Ⅲ	21(18.26)	11(21.57)
Ⅳ	91(79.13)	38(74.51)
手术方式[例(%)]
介入栓塞开颅夹闭	80(69.57) 35(30.43)	32(62.75) 19(37.25)	21.36	<0.001

Tab. 2 Univariate and multivariate logistic regression analyses of postoperative hydrocephalus in aSAH patients

变量	单因素分析		多因素分析
变量	OR(95%CI)	P值	OR(95%CI)	P值
年龄≥60岁	1.496(1.081~1.833)	0.009	1.170(1.060~1.343)	0.032
女性[例(%)]	1.159(0.585~2.296)	0.671	-	-
高血压[例(%)]	1.275(0.604~2.694)	0.523	-	-
吸烟[例(%)]	0.879(0.450~1.716)	0.707	-	-
酗酒[例(%)]	0.883(0.247~3.155)	0.848	-	-
糖尿病[例(%)]	2.075(0.226~19.021)	0.518	-	-
心血管疾病[例(%)]	1.333(0.546~3.252)	0.527	-	-
SAPSⅡ评分[例(%)]	1.040(0.691~1.565)	0.849	-	-
开颅夹闭[例(%)]	1.493(1.038~1.718)	<0.001	2.018(1.163~3.503)	0.041
脑室出血[例(%)]	1.414(1.214~1.799)	0.008	1.439(1.176~1.953)	0.032
再出血[例(%)]	1.456(1.211~1.984)	0.045	1.095(1.057~1.243)	<0.001
DCI[例(%)]	3.428(1.475~7.968)	0.004	1.318(1.096~1.576)	0.038
早期脑损伤[例(%)]	2.052(0.647~6.505)	0.221	-	-
血管痉挛[例(%)]	2.526(1.177~5.420)	0.057	-	-
机械通气时间(d)	2.320(1.378~3.907)	<0.001	3.112(1.840~5.309)	0.012
住院时间(d)	0.621(0.103~1.139)	0.090	-	-

Fig. 1 A nomogram to predict the risk of postoperative hydrocephalus in aSAH patients

Fig. 2 ROC curve for validating the performance of the nomogram in predicting the risk of postoperative hydrocephalus in aSAH patients a. Training set; b. Validation set

Fig. 3 Calibration curve for validating the performance of the nomogram in predicting the risk of postoperative hydrocephalus in aSAH patients a. Training set; b. Validation set

Fig. 4 DCA for validating the performance of the nomogram in predicting the risk of postoperative hydrocephalus in aSAH patients a. Training set; b. Validation set

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