Cerebral Ischemic Complications After Surgical Revascularization for Moyamoya Disease: Risk Factors and Development of a Predictive Model Based on Preoperative Nutritional Blood Parameters

Fangbao Li; Chuanfeng Li; Yunwei Sun; Yue Bao; Wenbo Jiang; Zuoyan Song; Yongyi Wang; Mingxing Liu; Weimin Wang; Tong Li; Luo Li

doi:10.3389/fnut.2022.842838

Cerebral Ischemic Complications After Surgical Revascularization for Moyamoya Disease: Risk Factors and Development of a Predictive Model Based on Preoperative Nutritional Blood Parameters

Front Nutr. 2022 Mar 10:9:842838. doi: 10.3389/fnut.2022.842838. eCollection 2022.

Authors

Fangbao Li^{1

2}, Chuanfeng Li¹, Yunwei Sun¹, Yue Bao¹, Wenbo Jiang¹, Zuoyan Song³, Yongyi Wang¹, Mingxing Liu¹, Weimin Wang¹, Tong Li¹, Luo Li¹

Affiliations

¹ Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China.
² School of Medicine, Dalian Medical University, Dalian, China.
³ Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, China.

Abstract

Objectives: Cerebral ischemic complications are common after revascularization in patients with moyamoya disease (MMD). Risk factors from specific laboratory variables have only been assessed by limited research. This study was to investigate the association between postoperative cerebral ischemia and nutritional blood parameters and examine predictive values of such risk factors in adults.

Methods: Preoperative demographics and nutritional blood parameters of patients with MMD who received revascularization at our institution from 2012 to 2021 were retrospectively reviewed. Univariate analysis and multivariable logistic regression were used to identify independent risk factors for the onset of postoperative cerebral ischemic complications. Predictive values were tested and a model incorporating these independent risk factors was created using the R program. Area under the receiver operating characteristic curve (AUC) was used for testing its discriminability.

Results: Postoperative cerebral ischemic complications occurred in 32 patients of 100 included procedures. Surgery on the left hemisphere, lower admission modified Rankin Scale (mRS) score, aberrant nutritional parameters including low white blood cell (WBC), and high total cholesterol (TC) were significantly associated with cerebral ischemic complications after revascularization. The intriguing role of WBC might be explained by altered immunomodulation. The AUC of this model with novel nutritional parameters yielded a value of 0.811, presenting better predictive accuracy. Additionally, the model was visualized in the form of a nomogram and translated into a user-friendly calculator to generate individual risk.

Conclusions: Surgical side, admission mRS score, WBC, and TC were independent risk factors for postoperative cerebral ischemic complications. The model composed of these four parameters was promising to be adopted in clinical practice.

Keywords: moyamoya disease; nutritional parameters; postoperative cerebral ischemia; predictive model; risk factor.