ArticleFrontiers in nutrition2026
Inflammation, coagulation, and nutritional reserves refine 90-day prognostic stratification after ruptured intracranial aneurysm repair.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Ruptured intracranial aneurysm is a major cause of neurological disability. Existing prognostic models primarily rely on neurological and radiological severity and may overlook systemic biological alterations. Objective: To evaluate whether integrating systemic immune-inflammation index (SII), D-dimer, and prognostic nutritional index (PNI) with clinical-radiological factors improves prediction of 90-day unfavorable neurological recovery after aneurysm repair. Methods: This single-center retrospective cohort study included 209 patients with aneurysmal subarachnoid hemorrhage undergoing clipping or coiling between January 2023 and December 2025. The primary outcome was unfavorable 90-day functional recovery (modified Rankin Scale 3-6). Admission biomarkers were analyzed using multivariable logistic regression. An admission model and an updated in-hospital model incorporating delayed cerebral ischemia (DCI) were developed and evaluated using discrimination, calibration, decision curve analysis, and bootstrap validation. Results: Among 209 patients, 66 (31.6%) had unfavorable outcomes. Independent predictors included Hunt-Hess grade IV-V (aOR 3.85, 95% CI 1.84-8.06), modified Fisher grade 3-4 (aOR 2.76, 95% CI 1.28-5.95), acute hydrocephalus (aOR 2.62, 95% CI 1.25-5.48), higher SII (aOR 1.32 per 500-unit increase), higher D-dimer (aOR 1.22 per 1 mg/L increase), and lower PNI (aOR 0.68 per 5-point increase). The admission model achieved an AUC of 0.82 (95% CI 0.76-0.88), while the updated model incorporating DCI improved the AUC to 0.86 (95% CI 0.80-0.91), with an optimism-corrected AUC of 0.83 after bootstrap validation. Conclusion: An integrated model combining inflammatory, coagulation, nutritional, and clinical-radiological factors improved risk stratification after ruptured intracranial aneurysm repair. Incorporation of DCI provided additional prognostic value, although external validation is needed.
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