NIHSS: A Possible Predictor of Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage

Background:The National Institutes of Health Stroke Scale (NIHSS) is a powerful and commonly used tool for predicting the prognosis of patients with either ischemic stroke or intracerebral hemorrhage.In this study, we investigated whether a correlation exists between the NIHSS score and the prognosis in aSAH patients and examined the predictive ability.Methods: This retrospective analysis included two cohorts of patients undergoing endovascular coiling for aSAH.Logistic regression models were used to predict the functional outcomes, which were evaluated using a modified Rankin Scale (mRS) at 3 months.Decision curve analysis (DCA) and a calibration curve were employed to assess the predictive accuracy and reliability of the models.Results: In the derivation cohort, the NIHSS on admission (OR, 1.08; 95% CI, 1.04-1.13,P < 0.001) was an independent predictor of the 3-month mRS in aSAH patients.The area under the curve (AUC) for the NIHSS was 0.806 with a 95% CI (0.771, 0.841).By incorporating the NIHSS into the fundamental model, which included age, modified Fisher scale score, and leukocyte count, a significant improvement in discrimination for unfavorable outcomes was observed (ACU 0.784 vs. 0.845).In the two validation groups, adding the NIHSS on admission (OR, 1.08; 95% CI, 1.04-1.11and OR, 1.2; 95% CI, 1.04-1.38)to the fundamental model resulted in a similar increase in overall performance.Conclusions: The higher NIHSS score on admission showed the worse prognosis in patients treated with endovascular embolization for aSAH.