Declined Serum Resolvin D1 Levels to Predict Severity and Prognosis of Human Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study

Figures

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  Figure 1. Study flowing-diagram to enroll suitable patients with aneurysmal subarachnoid hemorrhage. A total of 160 patients were recruited in accordance with the inclusion criteria; 37 patients met the exclusion criteria and were therefore excluded, leaving 123 patients for clinical investigation.

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  Figure 2. Serum resolvin D1 levels between controls and patients with aneurysmal subarachnoid hemorrhage. Patients exhibited significantly lower serum resolvin D1 levels than controls (P<0.001).

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  Figure 3. Serum resolvin D1 levels in relation to severity of aneurysmal subarachnoid hemorrhage. Serum resolvin D1 levels were significantly inversely correlated with Hunt-Hess scores (P<0.001; (A)), and modified Fisher scores (P<0.001; (B)) using univariate correlative analysis were also independently correlated with them (both P<0.05; (C)) and were significantly decreased in the order of Hunt-Hess scores from 1 to 5 (P<0.001; (D)) and modified Fisher scores from 1 to 4 (P<0.001; (E)).

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  Figure 4. Serum resolvin D1 levels in correlation with Extended Glasgow Outcome Scale scores at six months after aneurysmal subarachnoid hemorrhage. Serum resolvin D1 levels were significantly positively correlated with Extended Glasgow Outcome Scale scores six months after stroke (P<0.001; (A)) using univariate correlative analysis, were significantly increased in the order of Extended Glasgow Outcome Scale scores from 1 to 8 (P<0.001; (B)), and were also independently correlated with it (P<0.05; (C)).

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  Figure 5. Serum resolvin D1 levels in association with poor prognosis at six months after aneurysmal subarachnoid hemorrhage. Serum resolvin D1 levels were significantly lower in patients with poor prognosis than in those with good prognosis at six months after stroke (P<0.001; (A)) using univariate analysis and were also independently associated with post-stroke six-month poor prognosis (P<0.05; (B)).

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  Figure 6. Receiver operating characteristic curve with respect to serum resolvin D1 levels for predicting poor prognosis at 6 months after aneurysmal subarachnoid hemorrhage. Serum resolvin D1 levels significantly predicted six-month poor prognosis after stroke (P<0.001; (A)), and its combination with Hunt-Hess and modified Fisher scores had a significantly stronger prognostic capability than any one of them (all P>0.05; (B)).

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  Figure 7. Restricted cubic spline assessing linear relationship between serum resolvin D1 levels and risk of poor prognosis at 6 months after aneurysmal subarachnoid hemorrhage. Serum resolvin D1 levels linearly correlated with the risk of poor prognosis (P>0.05).

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  Figure 8. Nomogram visually describing prediction model integrating serum resolvin D1 levels Hunt-Hess scores and modified Fisher scores in prognostic prediction after aneurysmal subarachnoid hemorrhage. Nomogram could efficiently predict 6-month poor prognosis following aneurysmal subarachnoid hemorrhage.

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  Figure 9. Calibration curve determining model stability in prognostic prediction among patients with aneurysmal subarachnoid hemorrhage. Prediction model was comparatively stable in prognostication of aneurysmal subarachnoid hemorrhage in humans.

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  Figure 10. Decision curve investigating model clinical benefit in prognostic prediction of patients after aneurysmal subarachnoid hemorrhage. The prediction model containing serum resolvin D1 levels, Hunt-Hess scores, and modified Fisher scores showed a relatively high clinical benefit in predicting prognosis among patients with aneurysmal subarachnoid hemorrhage.