Number of Affected Relatives, Age, Smoking, and Hypertension Prediction Score for Intracranial Aneurysms in Persons with a Family History for Subarachnoid Hemorrhage
Zuurbier, Charlotte C.M.; Bourcier, Romain; Beaufils, Pacôme Constant Dit; Redon, Richard; Desal, Hubert; Bor, Anne S.E.; Lindgren, Antti E.; Rinkel, Gabriel J.E.; Greving, Jacoba P.; Ruigrok, Ynte M.
(2022) Stroke, volume 53, issue 5, pp. 1645 - 1650
(Article)
Abstract
Background: Persons with a positive family history of aneurysmal subarachnoid hemorrhage are at increased risk of aneurysmal subarachnoid hemorrhage. Preventive screening for intracranial aneurysms (IAs) in these persons is cost-effective but not very efficient. We aimed to develop and externally validate a model for predicting the probability of an IA
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at first screening in persons with a positive family history of aneurysmal subarachnoid hemorrhage. Methods: For model development, we studied results from initial screening for IA in 660 prospectively collected persons with ≥2 affected first-degree relatives screened at the University Medical Center Utrecht. For validation, we studied results from 258 prospectively collected persons screened in the University Hospital of Nantes. We assessed potential predictors of IA presence in multivariable logistic regression analysis. Predictive performance was assessed with the C statistic and a calibration plot and corrected for overfitting. Results: IA were present in 79 (12%) persons in the development cohort. Predictors were number of affected relatives, age, smoking, and hypertension (NASH). The NASH score had a C statistic of 0.68 (95% CI, 0.62-0.74) and showed good calibration in the development data. Predicted probabilities of an IA at first screening varied from 5% in persons aged 20 to 30 years with two affected relatives, without hypertension who never smoked, up to 36% in persons aged 60 to 70 years with ≥3 affected relatives, who have hypertension and smoke(d). In the external validation data IA were present in 67 (26%) persons, the model had a C statistic of 0.64 (95% CI, 0.57-0.71) and slightly underestimated IAs risk. Conclusions: For persons with ≥2 affected first-degree relatives, the NASH score improves current predictions and provides risk estimates for an IA at first screening between 5% and 36% based on 4 easily retrievable predictors. With the information such persons can now make a better informed decision about whether or not to undergo preventive screening.
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Keywords: Humans, Hypertension/complications, Intracranial Aneurysm/complications, Non-alcoholic Fatty Liver Disease, Risk Factors, Smoking/epidemiology, Subarachnoid Hemorrhage/diagnosis, Journal Article, Research Support, Non-U.S. Gov't
ISSN: 0039-2499
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: This study was supported by the Netherlands Cardiovascular Research Initiative: An initiative with support of the Dutch Heart Foundation, CVON2015-08 ERASE. This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (PRYSM, grant agreement No. 852173). Dr Zuurbier was supported by the Remmert Adriaan Laan Foundation. Dr Zuurbier reports a grant from Remmert Adriaan Laan Foundation, during the conduct of the study. We are grateful to the Clinical Investigation Center (INSERM CIC1413) for its assistance in managing the ICAN biobanks. Dr Redon was supported by the French Regional Council of Pays-de-la-Loire (VaCaRMe program) and the Agence Nationale de la Recherche (ANR-15-CE17-0008-01 to G.L), Drs Desal and Bourcier were supported by the French Ministry of Health (Clinical trial URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02848495 to Dr Desal), the Genavie Foundation, the Société Française de Radiologie and the Société française de Neuroradiologie. The funding organizations were not involved in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the article; and decision to submit the article for publication Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
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