{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:37Z","timestamp":1789535077719,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20136). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 209 patients, 66 (31.6%) had unfavorable outcomes. Independent predictors included Hunt\u2013Hess grade IV\u2013V (aOR 3.85, 95% CI 1.84\u20138.06), modified Fisher grade 3\u20134 (aOR 2.76, 95% CI 1.28\u20135.95), acute hydrocephalus (aOR 2.62, 95% CI 1.25\u20135.48), 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\u20130.88), while the updated model incorporating DCI improved the AUC to 0.86 (95% CI 0.80\u20130.91), with an optimism-corrected AUC of 0.83 after bootstrap validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1918951","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:32:55Z","timestamp":1789533175000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Inflammation, coagulation, and nutritional reserves refine 90-day prognostic stratification after ruptured intracranial aneurysm repair"],"prefix":"10.3389","volume":"13","author":[{"given":"Jian","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tianjin Medical University General Hospital, Heping","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tianjin Huanhu Hospital, Jinnan","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tianjin Medical University General Hospital, Heping","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tianjin Medical University General Hospital, Heping","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s40779-024-00551-6","article-title":"Epidemiological trends of subarachnoid hemorrhage at global, regional, and national level: a trend analysis study from 1990 to 2021","volume":"11","author":"Lv","year":"2024","journal-title":"Mil Med 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