Development and External Validation of a Dynamic Nomogram With Potential for Risk Assessment of Ruptured Multiple Intracranial Aneurysms

TingTing Chen; WeiGen Xiong; ZhiHong Zhao; YaJie Shan; XueMei Li; LeHeng Guo; Lan Xiang; Dong Chu; HongWei Fan; YingBin Li; JianJun Zou

doi:10.3389/fneur.2022.797709

Development and External Validation of a Dynamic Nomogram With Potential for Risk Assessment of Ruptured Multiple Intracranial Aneurysms

Front Neurol. 2022 Feb 8:13:797709. doi: 10.3389/fneur.2022.797709. eCollection 2022.

Authors

TingTing Chen^{1

2}, WeiGen Xiong^{1

2}, ZhiHong Zhao³, YaJie Shan³, XueMei Li⁴, LeHeng Guo³, Lan Xiang³, Dong Chu⁵, HongWei Fan^{2

6}, YingBin Li⁵, JianJun Zou^{2

6}

Affiliations

¹ School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.
² Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
³ Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, China.
⁴ Department of Neurology, The First Affiliated Hospital, Hunan University of Medicine, Huaihua, China.
⁵ Department of Neurosurgery, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China.
⁶ Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China.

Abstract

Background and purpose: About 20.1% of intracranial aneurysms (IAs) carriers are multiple intracranial aneurysms (MIAs) patients with higher rupture risk and worse prognosis. A prediction model may bring some potential benefits. This study attempted to develop and externally validate a dynamic nomogram to assess the rupture risk of each IA among patients with MIA.

Method: We retrospectively analyzed the data of 262 patients with 611 IAs admitted to the Hunan Provincial People's Hospital between November 2015 and November 2021. Multivariable logistic regression (MLR) was applied to select the risk factors and derive a nomogram model for the assessment of IA rupture risk in MIA patients. To externally validate the nomogram, data of 35 patients with 78 IAs were collected from another independent center between December 2009 and May 2021. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.

Result: Size, location, irregular shape, diabetes history, and neck width were independently associated with IA rupture. The nomogram showed a good discriminative ability for ruptured and unruptured IAs in the derivation cohort (AUC = 0.81; 95% CI, 0.774-0.847) and was successfully generalized in the external validation cohort (AUC = 0.744; 95% CI, 0.627-0.862). The nomogram was calibrated well, and the decision curve analysis showed that it would generate more net benefit in identifying IA rupture than the "treat all" or "treat none" strategies at the threshold probabilities ranging from 10 to 60% both in the derivation and external validation set. The web-based dynamic nomogram calculator was accessible on https://wfs666.shinyapps.io/onlinecalculator/.

Conclusion: External validation has shown that the model was the potential to assist clinical identification of dangerous aneurysms after longitudinal data evaluation. Size, neck width, and location are the primary risk factors for ruptured IAs.

Keywords: dynamic nomogram; multiple intracranial aneurysms; risk assessment; rupture; web-based calculator.