KLI

Development and validation of a risk scoring model for postoperative adult moyamoya disease

Metadata Downloads
Abstract
OBJECTIVE The current grading system for moyamoya disease (MMD) is focused on angiographic studies with limited clinical application. The authors aimed to determine relevant factors that may impact postoperative outcome and establish a scoring system to predict the functional outcome. METHODS Adult patients with MMD who underwent treatment between 1998 and 2016 were included. Factors such as age, sex, comorbidity, smoking, MMD family history, initial presentation, multimodal imaging modalities, and types of surgical revascularization were thoroughly reviewed. These factors were analyzed to determine possible risk factors related to unfavorable 6-month postoperative outcomes using the modified Rankin Scale (mRS) (unfavorable: mRS score ≥ 3). A scoring system was developed using these independent risk factors to predict the outcome and validated using prospectively collected data from multiple centers between 2017 and 2018. RESULTS Of 302 patients for whom applications were submitted, 260 patients (321 hemispheres) met the diagnostic criteria. In multivariate analysis, hyperlipidemia, smoking, cerebral infarction on preoperative CT or MRI, and moderately to severely reduced regional cerebrovascular reserve results from Diamox SPECT were significantly related to unfavorable outcome. The authors developed a scoring system and stratified patients into risk groups according to their scores: low-risk (score 0?3), intermediate-risk (score 4?6), and high-risk (score 7?9) groups. This model demonstrated both good discrimination and calibration using C-statistics and the Hosmer-Lemeshow goodness-of-fit test showing 0.812 (95% CI 0.743?0.881) (p = 0.568) for the development and 0.954 (95% CI 0.896?1) (p = 0.097) for the temporal and external validation cohort. CONCLUSIONS The authors’ scoring system is readily adoptable to predict the postoperative outcome for MMD. Their data revealed the importance of smoking and hyperlipidemia, which were the only modifiable factors included in the scoring system. The authors validated their scoring system both internally and externally and maintained good performance, highlighting the system’s generalizability and reliability.
Author(s)
김모이네박원형정연구이시운박중철권도훈안재성이승주
Issued Date
2021
Type
Article
Keyword
adultcerebrovascularmoyamoya diseaseprognosisscoringstrokesurgeryvascular disorders
DOI
10.3171/2020.2.JNS193221
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7878
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_crossref_primary_10_3171_2020_2_JNS193221&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Development%20and%20validation%20of%20a%20risk%20scoring%20model%20for%20postoperative%20adult%20moyamoya%20disease&offset=0&pcAvailability=true
Publisher
JOURNAL OF NEUROSURGERY
Location
미국
Language
영어
ISSN
0022-3085
Citation Volume
134
Citation Start Page
1505
Citation End Page
1514
Appears in Collections:
Medicine > Medicine
Authorize & License
  • Authorize공개
Files in This Item:
  • There are no files associated with this item.

Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.