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Lim MJR, Quek RHC, Ng KJ, Tan BYQ, Yeo LLL, Low YL, Soon BKH, Loh WNH, Teo K, Nga VDW, Yeo TT, Motani M. Prognostication of Outcomes in Spontaneous Intracerebral Hemorrhage: A Propensity Score-Matched Analysis with Support Vector Machine. World Neurosurg 2024; 182:e262-e269. [PMID: 38008171 DOI: 10.1016/j.wneu.2023.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The role of surgery in spontaneous intracerebral hemorrhage (SICH) remains controversial. We aimed to use explainable machine learning (ML) combined with propensity-score matching to investigate the effects of surgery and identify subgroups of patients with SICH who may benefit from surgery in an interpretable fashion. METHODS We conducted a retrospective study of a cohort of 282 patients aged ≥21 years with SICH. ML models were developed to separately predict for surgery and surgical evacuation. SHapley Additive exPlanations (SHAP) values were calculated to interpret the predictions made by ML models. Propensity-score matching was performed to estimate the effect of surgery and surgical evacuation on 90-day poor functional outcomes (PFO). RESULTS Ninety-two patients (32.6%) underwent surgery, and 57 patients (20.2%) underwent surgical evacuation. A total of 177 patients (62.8%) had 90-day PFO. The support vector machine achieved a c-statistic of 0.915 when predicting 90-day PFO for patients who underwent surgery and a c-statistic of 0.981 for patients who underwent surgical evacuation. The SHAP scores for the top 5 features were Glasgow Coma Scale score (0.367), age (0.214), volume of hematoma (0.258), location of hematoma (0.195), and ventricular extension (0.164). Surgery, but not surgical evacuation of the hematoma, was significantly associated with improved mortality at 90-day follow-up (odds ratio, 0.26; 95% confidence interval, 0.10-0.67; P = 0.006). CONCLUSIONS Explainable ML approaches could elucidate how ML models predict outcomes in SICH and identify subgroups of patients who respond to surgery. Future research in SICH should focus on an explainable ML-based approach that can identify subgroups of patients who may benefit functionally from surgical intervention.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
| | - Raphael Hao Chong Quek
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Kai Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Ying Liang Low
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Betsy Kar Hoon Soon
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Will Ne-Hooi Loh
- Department of Anesthesia, National University Hospital, Singapore, Singapore
| | - Kejia Teo
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Vincent Diong Weng Nga
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Mehul Motani
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health, National University of Singapore, Singapore, Singapore; Institute of Data Science, National University of Singapore, Singapore, Singapore; Institute for Digital Medicine (WisDM), National University of Singapore, Singapore, Singapore
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Yang CC, Lee MH, Chen KT, Lin MHC, Tsai PJ, Yang JT. In-hospital outcomes of patients with spontaneous supratentorial intracerebral hemorrhage. Medicine (Baltimore) 2022; 101:e29836. [PMID: 35777064 PMCID: PMC9239614 DOI: 10.1097/md.0000000000029836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) in the brain parenchyma accounts for 16.1% of all stroke types in Taiwan. It is responsible for high morbidity and mortality in some underlying causes. The objective of this study is to discover the predicting factors focusing on in-hospital outcomes of patients with spontaneous supratentorial ICH. Between June 2014 and October 2018, there were a total of 159 patients with spontaneous supratentorial ICH ranging from 27 to 91 years old in our institution. Twenty-three patients died during hospitalization, whereas 59 patients had an extended length of stay of >30 days. The outcomes were measured by inpatient death, length of stay, and activity of daily living (ADL). Both univariate and multivariate binary logistic regression, as well as multivariate linear regression, were used for statistical analysis. Multivariate binary linear regression analysis showed the larger hematoma in initial computed tomography scan of >30 cm3 (odds ratio [OR] = 2.505, P = .013) and concurrent in-hospital infection (OR = 4.173, P = .037) were both statistically related to higher mortality. On the other hand, in-hospital infection (≥17.41 days, P = .000) and surgery (≥11.23 days, P = .001) were correlated with a longer length of stay. Lastly, drastically poor change of ADL (ΔADL <-30) was associated with larger initial ICH (>30 cc, OR = 2.915, P = .049), in-hospital concurrent infection (OR = 4.695, P = .01), and not receiving a rehabilitation training program (OR = 3.473, P = .04). The results of this study suggest that age, prothrombin, initial Glasgow Coma Scale, computed tomography image, location of the lesion, and surgery could predict the mortality and morbidity of the spontaneous ICH, which cannot be reversed at the time of occurrence. However, effective control of international normalized ratio level, careful prevention against infection, and the aid of rehabilitation programs might be important factors toward a decrease of inpatient mortality rate, the length of stay, and ADL recovery.
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Affiliation(s)
- Chao-Chun Yang
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Ming-Hsue Lee
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Kuo-Tai Chen
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Martin Hsiu-Chu Lin
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Ping-Jui Tsai
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
- *Correspondence: Jen-Tsung Yang, No 6. West Sec, ChiaPu Rd, Puzi City, Chiayi County, Taiwan (e-mail: )
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Lin G, Xu X, Luan X, Qiu H, Shao S, Wu Q, Xu W, Huang G, He J, Feng L. A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic. Front Neurol 2022; 13:873061. [PMID: 35518200 PMCID: PMC9062182 DOI: 10.3389/fneur.2022.873061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Globally, intracerebral hemorrhage (ICH) is a common cerebrovascular disease. At the beginning of 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, the allocation of medical resources and the patient treatment and referrals were affected to varying degrees. We aimed to determine the characteristics and prognoses and associated factors of patients with ICH. Patients and Methods The baseline demographic characteristics and ICH outcomes were compared between patients diagnosed with ICH between January and June 2020 (the 2020 group) and between January and June 2019 (the 2019 group). COVID-19 positive patients were excluded from the study. A 30-day data from patients in the 2019 and 2020 groups were analyzed to create survival curves for these patients. We also used regression models to identify the significant determinants of poor outcomes [modified Rankin score (mRS): 3-6] and death. Results The number of patients diagnosed with ICH was slightly lower in the 2020 group (n = 707) than in the 2019 group (n = 719). During the lockdown period (February 2020), the admission rates for ICH decreased greatly by 35.1%. The distribution of the patients' domicile (P = 0.002) and the mRS (P < 0.001) differed significantly between the years. The survival curve revealed that the highest risk of death was in the acute stage (especially in the first 5 days) of ICH. At 30 days, mortality was 19.8% in February 2019 and 29.4% in February 2020 (P = 0.119). Multivariate analysis revealed age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine as factors significantly associated with poor outcomes and death following ICH. Neurosurgery and massive supratentorial hemorrhage were only correlated with the risk of death. Conclusion During the lockdown period, the COVID-19 pandemic caused a decrease in the admission rates and severe conditions at admission due to strict traffic constraints for infection control. This led to high mortality and disability in patients with ICH. It is necessary to ensure an effective green channel and allocate adequate medical resources for patients to receive timely treatment and neurosurgery.
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Affiliation(s)
- Gangqiang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqian Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengfang Shao
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qingsong Wu
- Medical Record Room, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Xu
- Outpatient Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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The Burden and Risks Factors for Intracerebral Hemorrhage in a Southeast Asian Population. Clin Neurol Neurosurg 2022; 214:107145. [DOI: 10.1016/j.clineuro.2022.107145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
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Lim MJR, Quek RHC, Ng KJ, Loh NHW, Lwin S, Teo K, Nga VDW, Yeo TT, Motani M. Machine Learning Models Prognosticate Functional Outcomes Better than Clinical Scores in Spontaneous Intracerebral Haemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106234. [PMID: 34896819 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aims to develop and compare the use of deep neural networks (DNN) and support vector machines (SVM) to clinical prognostic scores for prognosticating 30-day mortality and 90-day poor functional outcome (PFO) in spontaneous intracerebral haemorrhage (SICH). MATERIALS AND METHODS We conducted a retrospective cohort study of 297 SICH patients between December 2014 and May 2016. Clinical data was collected from electronic medical records using standardized data collection forms. The machine learning workflow included imputation of missing data, dimensionality reduction, imbalanced-class correction, and evaluation using cross-validation and comparison of accuracy against clinical prognostic scores. RESULTS 32 (11%) patients had 30-day mortality while 177 (63%) patients had 90-day PFO. For prognosticating 30-day mortality, the class-balanced accuracies for DNN (0.875; 95% CI 0.800-0.950; McNemar's p-value 1.000) and SVM (0.848; 95% CI 0.767-0.930; McNemar's p-value 0.791) were comparable to that of the original ICH score (0.833; 95% CI 0.748-0.918). The c-statistics for DNN (0.895; DeLong's p-value 0.715), and SVM (0.900; DeLong's p-value 0.619), though greater than that of the original ICH score (0.862), were not significantly different. For prognosticating 90-day PFO, the class-balanced accuracies for DNN (0.853; 95% CI 0.772-0.934; McNemar's p-value 0.003) and SVM (0.860; 95% CI 0.781-0.939; McNemar's p-value 0.004) were better than that of the ICH-Grading Scale (0.706; 95% CI 0.600-0.812). The c-statistic for SVM (0.883; DeLong's p-value 0.022) was significantly greater than that of the ICH-Grading Scale (0.778), while the c-statistic for DNN was 0.864 (DeLong's p-value 0.055). CONCLUSION We showed that the SVM model performs significantly better than clinical prognostic scores in predicting 90-day PFO in SICH.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore.
| | | | - Kai Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Ne-Hooi Will Loh
- Department of Anaesthesia, National University Hospital, Singapore
| | - Sein Lwin
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Mehul Motani
- Department of Electrical and Computer Engineering, National University of Singapore; N.1 Institute for Health, National University of Singapore; Institute for Data Science, National University of Singapore
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Validation of the ICH score and ICH-GS in a Peruvian surgical cohort: a retrospective study. Neurosurg Rev 2021; 45:763-770. [PMID: 34275028 DOI: 10.1007/s10143-021-01605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/28/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
The intracerebral hemorrhage (ICH) score and the ICH-grading scale (ICH-GS) are mortality predictor tools developed predominantly in conservatively treated ICH cohorts. We aimed to compare and evaluate the external validity of both models in predicting mortality in patients with ICH undergoing surgical intervention. A retrospective review of all patients presenting with spontaneous ICH admitted to a Peruvian national hospital between January 2018 and March 2020 was conducted. We compared the area under the receiver operating characteristic curve (AUC) for the ICH score and ICH-GS for in-hospital, 30-day, and 6-month mortality prediction. The research protocol was approved by the Institutional Review Board. A total of 73 patients (median age 62 years, 56.2% males) were included in the study. The mean ICH and ICH-GS scores were 2.5 and 8.7, respectively. In-hospital, 30-day, and 6-month mortality were 37%, 27.4%, and 37%, respectively. The AUC for in-hospital, 30-day, and 6-month mortality was 0.69, 0.71, and 0.69, respectively, for the ICH score and 0.64, 0.65, and 0.68, respectively, for the ICH-GS score. In this study, the ICH score and ICH-GS had moderate discrimination capacities to predict in-hospital, 30-day, and 6-month mortality in surgically treated patients. Additional studies should assess whether surgical intervention affects the discrimination of these prognostic models in order to develop predictive scores based on specific populations.
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