Analysis of risk factors and predictive model construction of cognitive impairment after aneurysmal subarachnoid hemorrhage

CAI Li; HUANG Xue-cai

doi:10.13820/j.cnki.gdyx.20230526

Abstract：Objective To Analyze the risk factors for cognitive impairment after aneurysmal subarachnoid hemor-rhage(aSAH)and construct a predictive model based on the results.Methods A total of 312 patients who received treatment for aSAH at our hospital were selected.Cognitive impairment was determined based on MMSE scores at 6 months postoperatively.Patients were categorized into control and cognitive impairment groups.Clinical data were collected,and risk factors influencing cognitive impairment after aSAH were analyzed.A predictive model was constructed and evaluated using the Hosmer-Lemeshow goodness-of-fit test,ROC curve analysis,and clinical utility assessment using decision curve analysis(DCA).Results Among the 312 patients included in the study,126(40.38％)experienced cognitive impairment after aSAH.Alcohol history,treatment method,Hunt-Hess grade,concomitant hypertension,and complica-tions were significantly associated with cognitive impairment after aSAH(P＜0.05).However,gender,age,education level,aneurysm diameter,smoking history,aneurysm location,postoperative cerebral infarction,multiple aneurysms,CT-Fisher grade,concomitant diabetes,and time from diagnosis to surgery were not related.Alcohol history,concomitant hypertension,and Hunt-Hess grade 3-4 were identified as independent risk factors for cognitive impairment after aSAH(P＜0.05).The ROC curve area under the curve for the predictive model was 0.754,with specificity and sensitivity of 91.40％and 77.94％,respectively.The Hosmer-Lemeshow test showed good model fit(x2=1.564,P=0.325).DCA analysis indicated clinical utility,particularly within a threshold probability range of 0.1-0.625.Conclusion Al-cohol history,concomitant hypertension,and Hunt-Hess grade 3-4 are independent risk factors for cognitive impairment after aSAH.The predictive model based on these factors demonstrates good discriminative ability and effectiveness,with high clinical utility.It provides a concise and intuitive way to predict the risk of cognitive impairment after aSAH in clini-cal practice.