Key result
The ARISE prediction models reliably estimated the risk of aneurysmal rerupture, achieving an optimism-corrected c-statistic of 0.77 for the base model and 0.79 for the extended model.
Why the study?
Aneurysmal rerupture frequently impacts outcomes after aneurysmal subarachnoid hemorrhage, but individual risk assessment is challenging due to heterogeneous patient characteristics and aneurysm morphology.
Does the ARISE prediction model reliably estimate the risk of aneurysmal rerupture within 24 and 72 hours after aneurysmal subarachnoid hemorrhage?
Cohort (n=2,075)
Yes
Does the ARISE prediction model reliably estimate the risk of aneurysmal rerupture within 24 and 72 hours after aneurysmal subarachnoid hemorrhage?
Effect estimate: c-statistic 0.79
The ARISE prediction model reliably estimates the risk of aneurysm rerupture after aneurysmal subarachnoid hemorrhage using variables available upon hospital admission.
May inform early rerupture risk stratification after aSAH; leaves open prospective validation and outcome impact.
BACKGROUND: Aneurysmal rerupture is one of the most important determents for outcome after aneurysmal subarachnoid hemorrhage and still occurs frequently because individual risk assessment is challenging given the heterogeneity in patient characteristics and aneurysm morphology. OBJECTIVE: To develop and internally validate a practical prediction model to estimate the risk of aneurysmal rerupture before aneurysm closure. METHODS: We designed a multinational cohort study of 2 prospective hospital registries and 3 retrospective observational studies to predict the risk of computed tomography confirmed rebleeding within 24 and 72 hours after ictus. We assessed predictors with Cox proportional hazard regression analysis. RESULTS: Rerupture occurred in 269 of 2075 patients. The cumulative incidence equaled 7% and 11% at 24 and 72 hours, respectively. Our base model included hypertension, World Federation of Neurosurgical Societies scale, Fisher grade, aneurysm size, and cerebrospinal fluid drainage before aneurysm closure and showed good discrimination with an optimism corrected c-statistic of 0.77. When we extend the base model with aneurysm irregularity, the optimism-corrected c-statistic increased to 0.79. CONCLUSION: Our prediction models reliably estimate the risk of aneurysm rerupture after aneurysmal subarachnoid hemorrhage using predictor variables available upon hospital admission. An online prognostic calculator is accessible at https://www.evidencio.com/models/show/2626 .
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Lieshout et al. (2022) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=2,075). ARISE Prediction Models was evaluated on computed tomography confirmed rebleeding within 24 and 72 hours after ictus (c-statistic 0.79). The ARISE prediction models reliably estimated the risk of aneurysmal rerupture, achieving an optimism-corrected c-statistic of 0.77 for the base model and 0.79 for the extended model.
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