Influencing factors and construction of a predictive model for cognitive dysfunction in patients with aneurysmal subarachnoid hemorrhage after interventional surgery

ZHANG Meng; ZHANG Zhen; JIN Xiaomin; LI Meng; DENG Jianping; YANG Xiaolin

Abstract：Objective To explore the factors affecting cognitive dysfunction in patients with aneurysmal subarachnoid hemorrhage(aSAH)after interventional surgery and to establish a risk prediction model.Methods 209 patients with aSAH admitted to the Department of Neurosurgery,the Second Affiliated Hospital of the Air Force Medical University from January 2020 to June 2024 were selected as the subjects of this study,and were divided into cognitive dysfunction group[Montreal Cognitive Assessment Scale(MoCA)score＜26,n=82]and normal cognitive function group(MoCA score≥26,n=127)according to the occurrence of cognitive dysfunction after interventional surgery.The influencing factors of cognitive dysfunction in patients with aSAH after interventional surgery were explored by Multivariate Logistic regression,and a nomogram model was constructed upon this analysis.The predictive value of the nomogram model for postoperative cognitive impairment in patients with aSAH was evaluated by ROC.Results The age of the cognitive dysfunction group≥60 years old,combined with hypertension,glasgow coma scale(GCS)score＜9,Hunt-Hess grade(Ⅲ-Ⅳ),Fisher grade(Ⅲ-Ⅳ),the maximum diameter of aneurysm≥5 mm and the proportion of ventricular drainage were higher than those of the normal cognitive function group,and the time from onset to admission was longer than that of the normal cognitive function group.Low density lipoprotein cholesterol(LDL-C)and D-dimer levels were higher than those in normal cognitive function group(P＜0.05).Multivariate analysis showed that patients with hypertension(OR=2.059,95%CI:1.461-2.901),GCS＜9 points at admission(OR=0.429,95%CI:0.294-0.626),Hunt-Hess classification(Ⅲ-Ⅳ)(OR=2.729,95%CI:1.777-4.192),elevated LDL-C(OR=2.489,95%CI:1.672-3.706),and elevated D-dimer(OR=3.080,95%CI:1.959-4.844)were independent risk factors for postoperative cognitive impairment in patients with aSAH(P＜0.05).A nomogram model was constructed to predict cognitive dysfunction in patients with aSAH after interventional surgery,and the results showed that the consistency index was 0.876(95%CI:0.823-0.929).The area under the curve was 0.879(95%CI:0.826-0.932),the specificity was 68.15%,and the sensitivity was 92.45%.Conclusions The risk factors for postoperative cognitive dysfunction in aSAH patients include hypertension,GCS score at admission,Hunt-Hess grade,LDL-C and D-dimer,and the nomogram model constructed on this analysis has a high predictive value for postoperative cognitive dysfunction in aSAH patients.