Development of a Complication- and Treatment-Aware Prediction Model for Favorable Functional Outcome in Aneurysmal Subarachnoid Hemorrhage Based on Machine Learning.

Maldaner, Nicolai; Zeitlberger, Anna M; Sosnova, Marketa; Goldberg, Johannes; Fung, Christian; Bervini, David; May, Adrien; Bijlenga, Philippe; Schaller, Karl; Roethlisberger, Michel; Rychen, Jonathan; Zumofen, Daniel W; D'Alonzo, Donato; Marbacher, Serge; Fandino, Javier; Daniel, Roy Thomas; Burkhardt, Jan-Karl; Chiappini, Alessio; Robert, Thomas; Schatlo, Bawarjan; ... (2021). Development of a Complication- and Treatment-Aware Prediction Model for Favorable Functional Outcome in Aneurysmal Subarachnoid Hemorrhage Based on Machine Learning. Neurosurgery, 88(2), E150-E157. Oxford University Press 10.1093/neuros/nyaa401

Text nyaa401.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (396kB)

BACKGROUND

Current prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission.

OBJECTIVE

To develop and validate a complication- and treatment-aware outcome prediction tool in aSAH.

METHODS

This cohort study included data from an ongoing prospective nationwide multicenter registry on all aSAH patients in Switzerland (Swiss SOS [Swiss Study on aSAH]; 2009-2015). We trained supervised machine learning algorithms to predict a binary outcome at discharge (modified Rankin scale [mRS] ≤ 3: favorable; mRS 4-6: unfavorable). Clinical and radiological variables on admission ("Early" Model) as well as additional variables regarding secondary complications and disease management ("Late" Model) were used. Performance of both models was assessed by classification performance metrics on an out-of-sample test dataset.

RESULTS

Favorable functional outcome at discharge was observed in 1156 (62.0%) of 1866 patients. Both models scored a high accuracy of 75% to 76% on the test set. The "Late" outcome model outperformed the "Early" model with an area under the receiver operator characteristics curve (AUC) of 0.85 vs 0.79, corresponding to a specificity of 0.81 vs 0.70 and a sensitivity of 0.71 vs 0.79, respectively.

CONCLUSION

Both machine learning models show good discrimination and calibration confirmed on application to an internal test dataset of patients with a wide range of disease severity treated in different institutions within a nationwide registry. Our study indicates that the inclusion of variables reflecting the clinical course of the patient may lead to outcome predictions with superior predictive power compared to a model based on admission data only.

Interest & Impact

Downloads

1 since deposited on 12 Oct 2020
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item