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Vyas V, Savitz SI, Boren SB, Becerril-Gaitan A, Hasan K, Suchting R, deDios C, Solberg S, Chen CJ, Brown RJ, Sitton CW, Grotta J, Aronowski J, Gonzales N, Haque ME. Serial Diffusion Tensor Imaging and Rate of Ventricular Blood Clearance in Patients with Intraventricular Hemorrhage. Neurocrit Care 2024:10.1007/s12028-024-02070-7. [PMID: 39085503 DOI: 10.1007/s12028-024-02070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/14/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND We developed a noninvasive biomarker to quantify the rate of ventricular blood clearance in patients with intracerebral hemorrhage and extension to the ventricles-intraventricular hemorrhage. METHODS We performed magnetic resonance imaging in 26 patients at 1, 14, 28, and 42 days of onset and measured their hematoma volume (HV), ventricular blood volume (VBV), and two diffusion metrics: fractional anisotropy (FA), and mean diffusivity (MD). The ipasilesional ventricular cerebral spinal fluid's FA and MD were associated with VBV and stroke severity scores (National Institute of Health Stroke Scale [NIHSS]). A subcohort of 14 patients were treated with external ventricular drain (EVD). A generalized linear mixed model was applied for statistical analysis. RESULTS At day 1, the average HVs and NIHSS scores were 14.6 ± 16.7 cm3 and 16 ± 8, respectively. A daily rate of 2.1% and 1.3% blood clearance/resolution were recorded in HV and VBV, respectively. Ipsilesional ventricular FA (vFA) and ventricular MD (vMD) were simultaneously decreased (vFA = 1.3% per day, posterior probability [PP] > 99%) and increased (vMD = 1.5% per day, PP > 99%), respectively. Patients with EVD exhibited a faster decline in vFA (1.5% vs. 1.1% per day) and an increase in vMD (1.8% vs. 1.5% per day) as compared with patients without EVD. Temporal change in vMD was associated with VBV; a 1.00-cm3 increase in VBV resulted in a 5.2% decrease in vMD (PP < 99%). VBV was strongly associated with NIHSS score (PP = 97-99%). A larger cerebral spinal fluid drained volume was associated with a greater decrease (PP = 83.4%) in vFA, whereas a smaller volume exhibited a greater increase (PP = 94.8%) in vMD. CONCLUSIONS In conclusion, vFA and vMD may serve as biomarkers for VBV status.
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Affiliation(s)
- Vedang Vyas
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Seth B Boren
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Andrea Becerril-Gaitan
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Khader Hasan
- Department of Interventional Diagnostic Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Constanza deDios
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Spencer Solberg
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert J Brown
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Clark W Sitton
- Department of Interventional Diagnostic Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James Grotta
- Department of Neurology, Memorial Hermann Hospital, Houston, TX, USA
| | - Jaroslaw Aronowski
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Nicole Gonzales
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
- Department of Neurology, University of Colorado, Boulder, CO, USA
| | - Muhammad E Haque
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA.
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Sun P, Badihian S, Avadhani R, Walborn N, Yarava A, Alimoradi D, Awad I, Hanley D, Murthy S, Ziai W. Does stereotactic thrombolysis with alteplase for intracerebral haemorrhage alter intraventricular haematoma volume? A secondary analysis of the MISTIE-III trial. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333032. [PMID: 38670789 DOI: 10.1136/jnnp-2023-333032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Stereotactic thrombolysis reduces intracerebral haemorrhage (ICH) volume in patients with spontaneous ICH. Whether intrahaematomal alteplase administration is associated with a change in intraventricular haemorrhage volume (deltaIVH) and functional outcomes is unknown. METHODS Post hoc secondary analysis of the Minimally Invasive Surgery plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III (MISTIE-III) trial in patients with IVH on the stability CT scan. Exposure was minimally invasive surgery plus alteplase (MIS+alteplase). Primary outcome was deltaIVH defined as IVH volume on end-of-treatment CT minus IVH volume on stability CT scan. Secondary outcomes were favourable functional outcome (modified Rankin Scale 0-3) and mortality at 365 days. We assessed the relationship between MIS+alteplase and deltaIVH in the primary analysis using multivariable linear regression, and between deltaIVH and functional outcomes in secondary analyses using multiple logistic regression. RESULTS Of 499 patients in MISTIE-III, 310 (62.1%) had IVH on stability scans; mean age (SD) was 61.2±12.3 years. A total of 146 (47.1%) received the MISTIE procedure and 164 (52.9%) standard medical care (SMC) only. The MIS+alteplase group had a greater mean reduction in IVH volume compared with the SMC group (deltaIVH: -2.35 (5.30) mL vs -1.15 (2.96) mL, p=0.02). While IVH volume decreased significantly in both treatment groups, in the primary analysis, MIS+alteplase was associated with greater deltaIVH in multivariable linear regression analysis adjusted for potential confounders (β -0.80; 95% CI -1.37 to -0.22, p=0.007). Secondary analysis demonstrated no associations between IVH reduction and functional outcomes (adjusted OR (aOR) for poor outcome 1.02; 95% CI 0.96 to 1.08, p=0.61; aOR for mortality 0.99; 95% CI 0.92 to 1.06, p=0.77). CONCLUSIONS Alteplase delivered into the ICH in MISTIE-III subjects with IVH was associated with a small reduction in IVH volume. This reduction did not translate into a significant benefit in mortality or functional outcomes at 365 days. TRIAL REGISTRATION NUMBER NCT01827046.
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Affiliation(s)
- Philip Sun
- Departments of Neurology, Anesthesiology & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shervin Badihian
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Radhika Avadhani
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nathan Walborn
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anusha Yarava
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
| | - Donya Alimoradi
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
| | - Issam Awad
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Daniel Hanley
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
| | - Santosh Murthy
- Department of Neurology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Wendy Ziai
- Departments of Neurology, Anesthesiology & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland, USA
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Jiang X, Zhou L, Sun Z, Xie B, Lin H, Gao X, Deng L, Yang C. MSCs overexpressing GDNF restores brain structure and neurological function in rats with intracerebral hemorrhage. MOLECULAR BIOMEDICINE 2023; 4:43. [PMID: 38008847 PMCID: PMC10678901 DOI: 10.1186/s43556-023-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023] Open
Abstract
Mesenchymal stem cells (MSCs) have been applied in transplantation to treat intracerebral hemorrhage (ICH) but with limited efficacy. Accumulated evidence has shown that glial cell-derived neurotrophic factor (GDNF) plays a crucial part in neuronal protection and functional recovery of the brain after ICH; however, GDNF has difficulty crossing the blood-brain barrier, which limits its application. In this study, we investigated the influences of MSCs overexpressing GDNF (MSCs/GDNF) on the brain structure as well as gait of rats after ICH and explored the possible mechanisms. We found that cell transplantation could reverse the neurological dysfunction and brain damage caused by ICH to a certain extent, and MSCs/GDNF transplantation was superior to MSCs transplantation. Moreover, Transplantation of MSCs overexpressing GDNF effectively reduced the volume of bleeding foci and increased the level of glucose uptake in rats with ICH, which could be related to improving mitochondrial quality. Furthermore, GDNF produced by transplanted MSCs/GDNF further inhibited neuroinflammation, improved mitochondrial quality and function, promoted angiogenesis and the survival of neurons and oligodendrocytes, and enhanced synaptic plasticity in ICH rats when compared with simple MSC transplantation. Overall, our data indicate that GDNF overexpression heightens the curative effect of MSC implantation in treating rats following ICH.
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Affiliation(s)
- Xiaoqian Jiang
- Department of Anatomy, College of Basic Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ling Zhou
- Clinical Skills Center, the Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zihuan Sun
- Department of Anatomy, College of Basic Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Bingqing Xie
- Laboratory of Neurological Diseases and Brain Function, the Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
- Institute of Epigenetics and Brain Science, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Heng Lin
- Department of Anatomy, College of Basic Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Xiaoqing Gao
- Department of Anatomy, College of Basic Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Li Deng
- Department of Anatomy, College of Basic Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Chaoxian Yang
- Department of Anatomy, College of Basic Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China.
- Department of Neurobiology, Preclinical Medicine Research Center, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Li CR, Yang MY, Cheng WY, Tseng HC, Lin YY, Liu YH, Shen CC, Yen CM. Urokinase administration for intraventricular hemorrhage in adults: A retrospective analysis of hemorrhage volume reduction and clinical outcomes. J Chin Med Assoc 2023; 86:930-934. [PMID: 37528523 DOI: 10.1097/jcma.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is a type of ventricular bleeding that results in significant morbidity and mortality. Multiple studies have investigated the use of urokinase in IVH treatment. The use of urokinase may lead to higher rates of hematoma resolution and lower mortality rates. However, further studies are required to determine efficacy of urokinase administration. This study examined the association between urokinase use, IVH volume reduction, and clinical outcomes. METHODS In total, 94 adult patients with hypertensive intracerebral hemorrhage with ventricular extension or primary IVH were enrolled between 2015 and 2021. Participants were categorized into two groups: "EVD combined with fibrinolysis" and "EVD only." The primary objective was to assess the reduction of IVH severity. Additionally, the study evaluated the functional outcomes and shunt dependency rate as secondary outcomes. Non-contrast computed tomography scans were obtained to measure the severity of IVH using the mGRAEB score. The main outcomes were the association among urokinase administration, reduced IVH severity, and functional outcomes. RESULTS There were no significant differences in the reduction rate of mGRAEB scores within a 7-day period (-50.0 [-64.4 to -32.5] % vs -44.2 [-59.3 to -7.9] %; p = 0.489). In addition, investigation of the third and fourth ventricles showed similar findings between the two groups. Urokinase treatment was not associated with significant differences in the modified Rankin Scale (5.0 (4.0-5.0) vs. 4.5 (4.0-5.0), p = 0.674) or shunt dependency rate (33.3% vs 39.3%, p = 0.58). CONCLUSION This study found that intraventricular urokinase use in patients with IVH was not associated with reduced IVH severity. In addition, urokinase use was not associated with better functional outcomes or minor shunt dependency rates.
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Affiliation(s)
- Chi-Ruei Li
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Oncology Neurosurgery Division, Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Wen-Yu Cheng
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan, ROC
| | - Huan-Chin Tseng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ying Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Hao Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiung-Chyi Shen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan, ROC
- Basic Medical Education, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Chun-Ming Yen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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Witsch J, Roh D, Oh S, Iadecola C, Diaz-Arrastia R, Kasner SE, Mayer SA, Murthy SB. Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial. Stroke 2023; 54:1726-1734. [PMID: 37226773 PMCID: PMC10330250 DOI: 10.1161/strokeaha.123.042466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Neutrophil-mediated inflammation in the acute phase of intracerebral hemorrhage (ICH) worsens outcome in preclinical studies. sICAM-1 (soluble intercellular adhesion molecule-1), an inducible ligand for integrins and cell-cell adhesion molecules, is critical for neutrophil extravasation. We aimed to determine whether serum levels of sICAM-1 are associated with worse outcomes after ICH. METHODS We conducted a post hoc secondary analysis of an observational cohort using data from the FAST trial (Factor-VII for Acute Hemorrhagic Stroke Treatment). The study exposure was the admission serum level of sICAM-1. The coprimary outcomes were mortality and poor outcome (modified Rankin Scale score 4-6) at 90 days. Secondary radiological outcomes were hematoma expansion at 24 hours and perihematomal edema expansion at 72 hours. We used multiple linear and logistic regression analyses to test for associations between sICAM-1 and outcomes, after adjustment for demographics, ICH severity characteristics, change in the systolic blood pressure in the first 24 hours, treatment randomization arm, and the time from symptom onset to study drug administration. RESULTS Of 841 patients, we included 507 (60%) with complete data. Hematoma expansion occurred in 169 (33%), while 242 (48%) had a poor outcome. In multivariable analyses, sICAM-1 was associated with mortality (odds ratio, 1.53 per SD increase [95% CI, 1.15-2.03]) and poor outcome (odds ratio, 1.34 per SD increase [CI, 1.06-1.69]). In multivariable analyses of secondary outcomes, sICAM-1 was associated with hematoma expansion (odds ratio, 1.35 per SD increase [CI, 1.11-1.66]), but was not associated with log-transformed perihematomal edema expansion at 72 hours. In additional analyses stratified by treatment assignment, similar results were noted in the recombinant activated factor-VII arm, but not in the placebo arm. CONCLUSIONS Admission serum levels of sICAM-1 were associated with mortality, poor outcome, and hematoma expansion. Given the possibility of a biological interaction between recombinant activated factor-VII and sICAM-1, these findings highlight the need to further explore the role of sICAM-1 as a potential marker of poor ICH outcomes.
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Affiliation(s)
- Jens Witsch
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Roh
- Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, New York, NY
| | - Stephanie Oh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephan A. Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
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Mezzacappa FM, Weisbrod LJ, Schmidt CM, Surdell D. Neuroendoscopic Evacuation Improves Outcomes Compared with External Ventricular Drainage in Patients with Spontaneous Intraventricular Hemorrhage: A Systematic Review with Meta-Analyses. World Neurosurg 2023; 175:e247-e253. [PMID: 36958716 DOI: 10.1016/j.wneu.2023.03.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Spontaneous intraventricular hemorrhage (IVH) is a cause of significant morbidity and mortality. Treatment for resulting obstructive hydrocephalus has traditionally been via an external ventricular drain (EVD). We aimed to compare patient outcomes after neuroendoscopic surgery (NES) evacuation of IVH versus EVD management. METHODS MEDLINE, Embase, and Cochrane Library databases were searched on October 8, 2022. Of the 252 records remaining after removal of duplicates, 12 met study inclusion criteria. After extraction of outcomes data, fixed-effect and random-effects models were used to establish odds ratios (ORs) with 95% confidence intervals (CIs) for intensive care unit length of stay, rate of permanent cerebrospinal fluid diversion, Glasgow Outcome Scale score, and mortality rate. RESULTS The results of the pooled analysis showed that intensive care unit length of stay was shorter (OR -2.61 [95% CI -5.02, -0.19]; I2 = 97.76%; P = 0.034), permanent cerebrospinal fluid diversion was less likely (OR -0.79, 95% CI [-1.17, -0.41], I2 = 46.96%, P < 0.001), higher Glasgow Outcome Scale score was more likely (OR 0.48, 95% CI [0.04, 0.93], I2 = 60.12%, P = 0.032), and all-cause mortality was less likely (OR -1.11, 95% CI [-1.79, -0.44], I2 = 0%, P = 0.001) in the NES evacuation group compared with the EVD group. CONCLUSIONS NES for evacuation of spontaneous IVH results in reduced intensive care unit length of stay, reduced permanent cerebrospinal fluid diversion rates, improved Glasgow Outcome Scale score, and reduced mortality when compared with EVD. More robust prospective, randomized studies are necessary to help inform the safety and utility of NES for IVH.
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Affiliation(s)
- Frank M Mezzacappa
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Luke J Weisbrod
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cindy M Schmidt
- McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel Surdell
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Chen X, Shi S, Hu L. High Levels of D-Dimer are Associated with Poor Hospitalization Outcome of Spontaneous Intraparenchymal Haemorrhage. Neuropsychiatr Dis Treat 2022; 18:1079-1086. [PMID: 35669230 PMCID: PMC9166298 DOI: 10.2147/ndt.s362331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate whether D-dimer levels and changes in D-dimer levels can be used as effective indexes to evaluate the risk of death among intraparenchymal haemorrhage (IPH) patients. METHODS A retrospective cohort study of 732 patients with IPH was conducted at an academic medical centre. The risk factors for adverse hospitalization outcomes were analysed, and logistic multivariate analysis was performed. Patients were divided into supratentorial, brainstem and cerebellum groups. According to whether intraventricular haematoma (IVH) and subarachnoid haematoma (SAH) co-occurred, the supratentorial group was divided into simple haematoma, combined IVH, combined SAH and combined IVH+SAH subgroups. The relationship between D-dimer levels and hospitalization outcome in each group/ subgroup was analysed. RESULTS Compared with survivors, the plasma D-dimer level of the nonsurvivors on the second day after admission was significantly higher (2.52 ± 3.89 μg/mL vs 0.77 ± 2.31 μg/mL, P = 0.032), and the difference in plasma D-dimer levels between the second day after admission and admission significantly increased (1.77 ± 3.70 μg/mL vs 0.26 ± 2.80 μg/mL, P = 0.049), and a D-dimer level on day 2 > 0.58 μg/mL was an independent risk factor for mortality among IPH patients (OR 3.114, 95% CI: 1.007). In the supratentorial group and the IVH subgroup, the level of D-dimer on day 2 was significantly higher among nonsurvivors than among survivors (2.18 ± 2.13 μg/mL vs 0.65 ± 1.04 μg/mL, P = 0.011; 2.45 ± 2.31 μg/mL vs 0.91 ± 1.26 μg/mL, P = 0.028, respectively). CONCLUSION The increase in plasma D-dimer levels on day 2 is related to poor hospitalization outcomes of patients with IPH, and this correlation may exist only among patients with both IVH and IPH.
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Affiliation(s)
- Xuguang Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medical, Shanghai, 201800, People's Republic of China
| | - Shengyi Shi
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medical, Shanghai, 201800, People's Republic of China
| | - Lan Hu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medical, Shanghai, 201800, People's Republic of China
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