Prediction of early postoperative functional outcomes in patients with aneurysmal subarachnoid hemorrhage: a Chinese bicenter retrospective study

Abstract Objectives This study aims to analyze the early functional outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) undergoing endovascular coiling or surgical clipping, and to construct predictive models based on both treatment modalities. Materials and Methods Patients diagnosed with aSAH were recruited from two Chinese hospitals between 1st January ,2015 and 31st December,2022. These patients were categorized into two groups: the endovascular coiling group and the surgical clipping group. Independent risk factors were determined using Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression. The relative weights of these significant factors were computed, and nomograms were developed accordingly. Subsequent validation analyses were conducted to assess the performance of the nomograms. Results Multifactorial analyses revealed that Hunt-Hess grade, GCS score, mFS, D-dimer, age, and body temperature can predict early functional outcomes of endovascular coiling (all P values P values < 0.05). Further computation of weights showed that the contributions of Hunt-Hess grade, mFS, GCS score and D-dimer were 32.78%, 31.99%, 4.63% and 13.73%, respectively, for endovascular coiling, and 33.55%, 38.02%, 8.44% and 19.99% for surgical clipping. Nomograms were constructed for the endovascular coiling and surgical clipping groups, and their discriminative ability and clinical utility were validated using ROC curves, calibration curves, and DCA curves, demonstrating good performance. Conclusion This study developed predictive nomogram models for early functional outcomes of patients with aSAH undergoing endovascular coiling or surgical clipping. It underscores the significance of scoring systems and clinical parameters (such as D-dimer), showing strong clinical utility.