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Detchou D, Darko K, Barrie U. Practical pearls for management of cranial injury in the developing world. Neurosurg Rev 2024; 47:579. [PMID: 39251507 DOI: 10.1007/s10143-024-02822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 08/25/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024]
Abstract
Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality, with approximately 69 million individuals affected globally each year, particularly in low- and middle-income countries (LMICs) where neurosurgical resources are limited. The neurocognitive consequences of TBI range from life-threatening conditions to more subtle impairments such as cognitive deficits, impulsivity, and behavioral changes, significantly impacting patients' reintegration into society. LMICs bear about 70% of the global trauma burden, with causes of TBI differing from high-income countries (HICs). The lack of equitable neurosurgical care in LMICs exacerbates these challenges. Improving TBI care in LMICs requires targeted resource allocation, neurotrauma registries, increased education, and multidisciplinary approaches within trauma centers. Reports from successful neurotrauma initiatives in low-resource settings provide valuable insights into safe, adaptable strategies for managing TBI when "gold standard" protocols are unfeasible. This review discusses common TBI scenarios in LMICs, highlighting key epidemiological factors, diagnostic challenges, and surgical techniques applicable to resource-limited settings. Specific cases, including epidural hematoma, subdural hematoma, subarachnoid hemorrhage, and cerebrospinal fluid leaks, are explored to provide actionable insights for improving neurosurgical outcomes in LMICs.
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Affiliation(s)
- Donald Detchou
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kwadwo Darko
- Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Umaru Barrie
- Department of Neurosurgery, New York University Grossman School of Medicine, New York City, NYC, USA
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2
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Sagues E, Gudino A, Dier C, Aamot C, Samaniego EA. Outcomes Measures in Subarachnoid Hemorrhage Research. Transl Stroke Res 2024:10.1007/s12975-024-01284-3. [PMID: 39073651 DOI: 10.1007/s12975-024-01284-3] [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: 04/12/2024] [Revised: 06/18/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
Despite advancements in acute management, morbidity rates for subarachnoid hemorrhage (SAH) remain high. Therefore, it is imperative to utilize standardized outcome scales in SAH research for evaluating new therapies effectively. This review offers a comprehensive overview of prevalent scales and clinical outcomes used in SAH assessment, accompanied by recommendations for their application and prognostic accuracy. Standardized terminology and diagnostic criteria should be employed when reporting pathophysiological outcomes such as symptomatic vasospasm and delayed cerebral ischemia. Furthermore, integrating clinical severity scales like the World Federation of Neurosurgical Societies scale and modified Fisher score into clinical trials is advised to evaluate their prognostic significance, despite their limited correlation with outcomes. The modified Rankin score is widely used for assessing functional outcomes, while the Glasgow outcome scale-extended version is suitable for broader social and behavioral evaluations. Avoiding score dichotomization is crucial to retain valuable information. Cognitive and behavioral outcomes, though frequently affected in patients with favorable neurological outcomes, are often overlooked during follow-up outpatient visits, despite their significant impact on quality of life. Comprehensive neuropsychological evaluations conducted by trained professionals are recommended for characterizing cognitive function, with the Montreal Cognitive Assessment serving as a viable screening tool. Additionally, integrating psychological inventories like the Beck Depression and Anxiety Inventory, along with quality-of-life scales such as the Stroke-Specific Quality of Life Scale, can effectively assess behavioral and quality of life outcomes in SAH studies.
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Affiliation(s)
- Elena Sagues
- Department of Neurology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA
| | - Andres Gudino
- Department of Neurology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA
| | - Carlos Dier
- Department of Neurology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA
| | - Connor Aamot
- Department of Neurology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA.
- Department of Radiology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA.
- Department of Neurosurgery, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA.
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3
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Tabowei G, Dadzie SK, Ahmed S, Lohana M, Shahzad M, Zehra SN, Zubair M, Khan A. Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e64311. [PMID: 39130937 PMCID: PMC11316346 DOI: 10.7759/cureus.64311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.
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Affiliation(s)
- Godfrey Tabowei
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Samuel K Dadzie
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Saeed Ahmed
- Cardiology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, PAK
| | - Muskan Lohana
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | | | | | | | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
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Couret D, Boussen S, Cardoso D, Alonzo A, Madec S, Reyre A, Brunel H, Girard N, Graillon T, Dufour H, Bruder N, Boucekine M, Meilhac O, Simeone P, Velly L. Comparison of scales for the evaluation of aneurysmal subarachnoid haemorrhage: a retrospective cohort study. Eur Radiol 2024:10.1007/s00330-024-10814-4. [PMID: 38836940 DOI: 10.1007/s00330-024-10814-4] [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: 11/03/2023] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND/OBJECTIVES Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening event with major complications. Delayed cerebral infarct (DCI) occurs most frequently 7 days after aSAH and can last for a prolonged period. To determine the most predictive radiological scales in grading subarachnoid or ventricular haemorrhage or both for functional outcome at 3 months in a large aSAH population, we conducted a single-centre retrospective study. METHODS A 3-year single-centre retrospective cohort study of 230 patients hospitalised for aSAH was analysed. Initial computed tomography (CT) scans in patients hospitalised for aSAH were blindly assessed using eight grading systems: the Fisher grade, modified Fisher grade, Barrow Neurological Institute scale, Hijdra scale, Intraventricular Haemorrhage (IVH) score, Graeb score and LeRoux score. RESULTS Of 200 patients with aSAH who survived to day 7 and were included for DCI analysis, 39% of cases were complicated with DCI. The Hijdra scale was the best predictor for DCI, with a receiver operating characteristic area under the curve (ROCAUC) of 0.80 (95% confidence interval (CI), 0.74-0.85). The IVH score was the most effective grading system for predicting acute hydrocephalus, with a ROCAUC of 0.85 (95% CI, 0.79-0.89). In multivariate analysis, the Hijdra scale was the best predictor of the occurrence of DCI (hazard ratio, 1.18; 95% CI, 1.10-1.25). CONCLUSIONS Although these results have yet to be prospectively confirmed, our findings suggest that the Hijdra scale may be a good predictor of DCI and could be useful in daily clinical practice. CLINICAL RELEVANCE STATEMENT Better assessment of subarachnoid haemorrhage patients would allow for better prognostication and management of expectations, as well as referral for appropriate services and helping to appropriate use limited critical care resources. KEY POINTS Aneurysmal subarachnoid haemorrhage is a life-threatening event that causes severe disability and leads to major complications such as delayed cerebral infarction. Accurate assessment of the amount of blood in the subarachnoid spaces on computed tomography with the Hijdra scale can better predict the risk of delayed cerebral infarct. The Hijdra scale could be a good triage tool for subarachnoid haemorrhage patients.
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Affiliation(s)
- David Couret
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France.
- Neurocritical Care Unit, University Hospital Saint Pierre, Réunion Univ, BP 350, Saint Pierre, 97448, La Réunion, France.
- Reunion Island University, INSERM, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint Denis de la Réunion, France.
| | - Salah Boussen
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
| | - Dan Cardoso
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
| | - Audrey Alonzo
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
| | - Sylvain Madec
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
| | - Anthony Reyre
- Department of Radiology, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Hervé Brunel
- Department of Radiology, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Nadine Girard
- Department of Radiology, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Nicolas Bruder
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
| | - Mohamed Boucekine
- Centre D'Etudes Et de Recherches Sur Les Services de Santé Et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Olivier Meilhac
- Reunion Island University, INSERM, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint Denis de la Réunion, France
| | - Pierre Simeone
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
- CNRS, INT, Inst Neurosci Timone, Aix Marseille Univ, Marseille, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, University Hospital Timone, Marseille, France
- CNRS, INT, Inst Neurosci Timone, Aix Marseille Univ, Marseille, France
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Monteiro A, Khan A, Donnelly BM, Kuo CC, Burke SM, Waqas M, Housley SB, Cappuzzo JM, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Treatment of ruptured intracranial aneurysms using the novel generation of flow-diverters with surface modification: A systematic review and meta-analysis. Interv Neuroradiol 2024; 30:350-360. [PMID: 35929825 PMCID: PMC11310723 DOI: 10.1177/15910199221117921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surface modification of flow diverters (FDs) has been explored as a solution for reducing thrombotic risk of these devices, without necessarily using dual antiplatelet therapy (DAPT). If effective, this could pose a promising alternative for treatment of ruptured aneurysms not amenable to other modalities. METHODS We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following Preferred Reporting Items for Systematic reviews and Meta-analyzes guidelines. We included articles reporting use of surface-modified FDs for treatment of ruptured aneurysms. Demographics, subarachnoid hemorrhage (SAH) severity, aneurysm characteristics, devices used, periprocedural complications, angiographic outcomes, and mortality were extracted for sample size-based weighted analysis. RESULTS Six studies comprising 59 patients with 64 aneurysms were included. Mean patient age was 56.6 ± 6.3 years and 60.6% (95% confidence interval [CI], 46.7-72.9%) were women. The anterior circulation was the location in 60.4% (95%CI, 45.5-73.5%) of aneurysms; 41.8% of the aneurysms were saccular (95%CI, 29.3-55.4%), 16.7% were fusiform (95%CI, 8.3-30.8%), 29.9% were dissecting (95%CI, 12.8-55.4%), 24.4% were blood-blister (95%CI, 15.2-36.7%), and 5.7% were mycotic (95%CI, 2-15.1%). Poor SAH grade was reported in 46.9% (95%CI, 33.3-60.9%). Adjunctive coiling was used in 33.2% (95%CI, 12.4-63.6%). Periprocedural thromboembolic and hemorrhagic complications occurred in 20% (95%CI, 7.1-45.1%) and 8.8% (95%CI, 3.7-19.5%), respectively. Complete occlusion was achieved in 76.4% (95%CI, 58.1-88.3%); no retreatments during follow-up were reported. Overall mortality was 15.1% (95%CI, 7.7-27.6%). There were no differences between single antiplatelet therapy (SAPT) and DAPT regimens with respect to periprocedural thromboembolic complications (P = 0.09), hemorrhagic (P = 0.834) complications, and mortality (P = 0.312). CONCLUSION Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality.
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Affiliation(s)
- Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Samantha M Burke
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Liu Z, Tan Y, Wei Y, Dai D, Zhao R, Li Q, Huang Q, Xu Y, Yang P, Sun J, Liu J, Zuo Q. Textbook Outcomes Among Patients with Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment. Neurol Ther 2024; 13:373-387. [PMID: 38263492 PMCID: PMC10951154 DOI: 10.1007/s40120-024-00577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The case fatality rate among patients with aneurysmal subarachnoid hemorrhage (aSAH) has decreased progressively, with numerous patients subjected to contemporary paradigms that minimize the use of agonizing therapeutic processes. The concept of the "Textbook Outcome" (TO), a composite outcome that highlights numerous favorable outcomes, was developed in the context of gastrointestinal tumor surgeries and expeditiously extended across diverse surgical spheres. The aim of this study was to explore the factors hindering the achievement of optimal prognoses in postinterventional aSAH patients, employ textbook outcomes, and establish predictive models. METHODS We conducted a retrospective review of data from 1270 aSAH patients who received endovascular treatment between 2012 and 2018. We delineated an exemplary TO within the aSAH domain, characterized by favorable clinical results, minimal complications, and the absence of retreatments. This TO-oriented approach is explained within the manuscript. RESULTS The findings revealed that preoperative intraventricular hemorrhage (IVH), preoperative Hunt and Hess grade (H&H) ≥ 3, World Federation of Neurosurgical Societies (WFNS) grade ≥ 3, the presence of blebs on the aneurysm, aneurysms situated at branching sites, and non-stent-assisted endovascular intervention were the strongest risk factors for not achieving textbook outcomes (non-"Textbook Outcome" [N-TO]). Decision curve analysis and calibration analyses revealed strong concordance between the predictions of the N-TO nomogram model and the actual observations. CONCLUSIONS Treatment Outcomes hold significant practical value in clinical studies of aSAH patients receiving endovascular treatment. The likelihood of N-TOs was predicted by IVH, H&H grade ≥ 3, WFNS grade ≥ 2, presence o f bleb on the aneurysm, and aneurysms located at branching sites.
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Affiliation(s)
- Zisheng Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
- Panvascular Disease Management Center, Wenzhou Central Hospital, Zhejiang, 325000, Wenzhou, China
| | - Yuhao Tan
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yanpeng Wei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Dongwei Dai
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Qiang Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yi Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Jun Sun
- Panvascular Disease Management Center, Wenzhou Central Hospital, Zhejiang, 325000, Wenzhou, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Qiao Zuo
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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7
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Hofmann BB, Donaldson DM, Neyazi M, Abusabha Y, Beseoglu K, Hänggi D, Cornelius JF, Fischer I, Muhammad S. Clinical Outcome Prediction of Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage: the SHELTER-Score. Neurocrit Care 2024; 40:438-447. [PMID: 38030877 PMCID: PMC10959788 DOI: 10.1007/s12028-023-01879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Despite intensive research on preventing and treating vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (aSAH), mortality and morbidity rates remain high. Early brain injury (EBI) has emerged as possibly the major significant factor in aSAH pathophysiology, emphasizing the need to investigate EBI-associated clinical events for improved patient management and decision-making. This study aimed to identify early clinical and radiological events within 72 h after aSAH to develop a conclusive predictive EBI score for clinical practice. METHODS This retrospective analysis included 561 consecutive patients with aSAH admitted to our neurovascular center between 01/2014 and 09/2022. Fourteen potential predictors occurring within the initial 72 h after hemorrhage were analyzed. The modified Rankin Scale (mRS) score at 6 months, discretized to three levels (0-2, favorable; 3-5, poor; 6, dead), was used as the outcome variable. Univariate ordinal regression ranked predictors by significance, and forward selection with McFadden's pseudo-R2 determined the optimal set of predictors for multivariate proportional odds logistic regression. Collinear parameters were excluded, and fivefold cross-validation was used to avoid overfitting. RESULTS The analysis resulted in the Subarachnoid Hemorrhage Associated Early Brain Injury Outcome Prediction score (SHELTER-score), comprising seven clinical and radiological events: age (0-4 points), World Federation of Neurosurgical Societies (0-2.5 points), cardiopulmonary resuscitation (CPR) (2 points), mydriasis (1-2 points), midline shift (0.5-1 points), early deterioration (1 point), and early ischemic lesion (2 points). McFadden's pseudo-R2 = 0.339, area under the curve for death or disability 0.899 and 0.877 for death. A SHELTER-score below 5 indicated a favorable outcome (mRS 0-2), 5-6.5 predicted a poor outcome (mRS 3-5), and ≥ 7 correlated with death (mRS 6) at 6 months. CONCLUSIONS The novel SHELTER-score, incorporating seven clinical and radiological features of EBI, demonstrated strong predictive performance in determining clinical outcomes. This scoring system serves as a valuable tool for neurointensivists to identify patients with poor outcomes and guide treatment decisions, reflecting the great impact of EBI on the overall outcome of patients with aSAH.
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Affiliation(s)
- Björn B Hofmann
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany.
| | - Daniel M Donaldson
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - Milad Neyazi
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - Yousef Abusabha
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - Igor Fischer
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, Düsseldorf, Germany
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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8
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Hofmann BB, Fischer I, Neyazi M, Karadag C, Donaldson DM, Abusabha Y, Muhammad S, Beseoglu K, Cornelius JF, Hänggi D. Revisiting the WFNS Score: Native Computed Tomography Imaging Improves Identification of Patients With "False Poor Grade" Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2024; 94:515-523. [PMID: 37823661 DOI: 10.1227/neu.0000000000002715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In patients suffering from aneurysmal subarachnoid hemorrhage (aSAH), the optimal time to determine the World Federation of Neurosurgical Societies (WFNS) score remains controversial because of possible confounding factors. Goals of this study were (1) to analyze the most sensitive timepoint to determine the WFNS score in patients with aSAH and (2) to evaluate the impact of initial native computed tomography (CT) imaging on reducing the mismatch of "false poor grade" patients. METHODS We retrospectively analyzed daily WFNS scores from admission until day 7 in 535 aSAH patients and evaluated their predictive value for the modified Rankin Scale at discharge and 6 months postbleeding. Patients with an initial WFNS score of IV-V who showed improvement to a WFNS score of I-II within the first 7 days (even short-term) were defined as "false poor grade" patients. We tried to identify the "false poor grade" patients using parameters of the initial native CT imaging. RESULTS Later determination of the WFNS score (day 1 vs 7; pseudo-R 2 = 0.13 vs 0.21) increasingly improved its predictive value for neurological outcome at discharge ( P < .001). We identified 39 "false poor grade" patients who had significantly better outcomes than "real poor grade" patients (N = 220) (modified Rankin Scale-discharge: 0-2, 56% vs 1%, P < .001; 3-5: 41% vs 56%, P = .12; 6: 3% vs 43%, P < .001). "False poor grade" patients differed significantly in initial CT parameters. A predictive model called "initial CT WFNS" ( ICT WFNS) was developed, incorporating SEBES, Hijdra score, and LeRoux score (sensitivity = 0.95, specificity = 0.84, accuracy = 0.859, F1 = 0.673). ICT WFNS scores of ≤4.6 classified patients as "false poor grade." CONCLUSION The initial WFNS score may misclassify a subgroup of patients with aSAH as poor grade, which can be avoided by later determination of the WFNS score, at days 3-4 losing its usefulness. Alternatively, the initial WFNS score can be improved in its predictive value, especially in poor-grade patients, using criteria from the initial native CT imaging, such as the Hijdra, LeRoux, and Subarachnoid Hemorrhage Early Brain Edema score, combined in the ICT WFNS score with even higher predictive power.
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Affiliation(s)
- Björn B Hofmann
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Igor Fischer
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Milad Neyazi
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Cihat Karadag
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Daniel M Donaldson
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Yousef Abusabha
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki , Finland
| | - Kerim Beseoglu
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf , Germany
| | - Daniel Hänggi
- Department of Neurosurgery, International Neuroscience Institute, Hannover , Germany
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9
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Sato A, Kitazawa K, Nishikawa A, Murata T, Wada N, Seguchi T, Hanaoka Y, Kobayashi S, Abe D, Yamamoto Y, Sasaki T, Murase H, Hongo K, Horiuchi T. Proposed imaging assessment score for aneurysmal subarachnoid hemorrhage correlated with prognosis: Shinshu Aneurysmal subarachnoid hemorrhage score. J Clin Neurosci 2024; 119:30-37. [PMID: 37976912 DOI: 10.1016/j.jocn.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) imaging has been shown to correlate with prognosis. However, no numerical index of bleeding severity has been established. This study aimed to propose a new simple scoring system for computed tomography imaging of aSAH and to confirm its effectiveness in retrospective and prospective studies. METHODS We devised an image evaluation system as an objective index. This system was established by scoring six items, with a maximum total of 19 points. Using this score, named the Shinshu Aneurysmal Subarachnoid Hemorrhage Score (S-score), we performed a retrospective study of 210 patients with aSAH at a single institution to confirm its efficacy. Age and World Federation of Neurosurgical Societies grades were adopted as other verification items, and the modified Rankin Scale was used for prognostic evaluation. A multicenter prospective study was then conducted to examine the function of the score by examining 214 patients with aSAH. RESULTS In the retrospective study, the threshold of the S-score between good and poor prognoses was 9/19 points. The area under the curve by receiver operating characteristic analysis of the S-score was 0.819, suggesting efficacy, with an odds ratio (OR) of 1.291 (1.077-1.547). In the prospective study, the judgment capability of the S-score was evaluated with a sensitivity of 0.674, specificity of 0.881, positive predictive value of 0.789, negative predictive value of 0.804, false-positive ratio of 0.119, false-negative ratio of 0.325, positive likelihood ratio of 6.072, and negative likelihood ratio of 1.369. S-score showed a significant difference in prognosis. The OR was 1.183 (1.009-1.388). CONCLUSIONS The scoring system could contribute to patient prognosis assessment. S-score and its prognostic formulas may serve as an objective source of information in the development of clinical medicine.
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Affiliation(s)
- Atsushi Sato
- Division of Neurosurgery, Ina Central Hospital, Ina, Nagano, Japan.
| | - Kazuo Kitazawa
- Division of Neurosurgery, Aizawa Hospital, Matsumoto, Nagano, Japan
| | | | - Takahiro Murata
- Division of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
| | - Naomichi Wada
- Division of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | | | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | | | - Daishiro Abe
- Division of Neurosurgery, Iida Hospital, Iida, Japan
| | | | - Tetsuo Sasaki
- Division of Neurosurgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Hiromu Murase
- Division of Neurosurgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Kazuhiro Hongo
- Division of Neurosurgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University Hospital, Matsumoto, Nagano, Japan
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10
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Rojas-Panta G, Reyes-Narro GF, Toro-Huamanchumo C, Choque-Velasquez J, Saal-Zapata G. Prognostic value of scales for aneurysmal subarachnoid hemorrhage: Report of a reference center in Peru. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:1-5. [PMID: 37295495 DOI: 10.1016/j.neucie.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Multiple scales have been designed to stratify the severity and predict the prognosis in the initial evaluation of patients with aneurysmal subarachnoid hemorrhage (aSAH). Our study aimed to validate the most commonly used prognostic scales for aSAH in our population: Hunt-Hess, modified Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH), and Barrow Aneurysm Institute (BAI) scales. METHODS This study includes all aSAH cases treated at our institution between June 2019 and December 2020. We developed a retrospective cohort by reviewing medical records and radiologic images performed during hospitalization. The outcome was evaluated using the modified Rankin scale (mRS). It was defined as a poor outcome (mRS 4-5) and mortality (mRS 6). The ROC curves and the area under the curve (AUC) of each of the prognostic scales were calculated to evaluate their prognostic prediction capacity. RESULTS A total of 142 patients were diagnosed with aSAH. A poor outcome occurred in 52.1% of the patients, whereas mortality was 27.5%. The AUC of the scales studied was similar and no significant difference was found between them for predicting a poor outcome (P = .709) or mortality (P = .715). CONCLUSION We determined that the prognostic scales for aSAH had a similar predictive value for poor clinical outcomes and mortality in our institution, with no significant difference. Thus, we recommend the most simple and well-known scale used institutionally.
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Affiliation(s)
- Giuseppe Rojas-Panta
- Departamento de Neurocirugía, Servicio de Neurocirugía Vascular y Tumores, Hospital Nacional Guillermo Almenar Irigoyen-EsSalud, Lima, Peru.
| | - Gian F Reyes-Narro
- Departamento de Neurocirugía, Servicio de Neurocirugía Vascular y Tumores, Hospital Nacional Guillermo Almenar Irigoyen-EsSalud, Lima, Peru
| | - Carlos Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Joham Choque-Velasquez
- Unidad de Neurocirugía, Hospital Regional del Cusco, Cusco, Peru; Facultad de Ciencias de la Salud, Escuela Profesional de Medicina Humana, Universidad Andina del Cusco, Cusco, Peru
| | - Giancarlo Saal-Zapata
- Departamento de Neurocirugía, Servicio de Neurocirugía Endovascular, Hospital Nacional Guillermo Almenar Irigoyen-EsSalud, Lima, Peru; Clínica Angloamericana, San Isidro, Lima, Peru
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11
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Wang L, Chen L, Jin Y, Cao X, Xue L, Cheng Q. Clinical value of the low-grade inflammation score in aneurysmal subarachnoid hemorrhage. BMC Neurol 2023; 23:436. [PMID: 38082254 PMCID: PMC10712030 DOI: 10.1186/s12883-023-03490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Multiple inflammatory biomarkers have been shown to predict symptomatic cerebral vasospasm (SCVS) and poor functional outcome in patients with aneurysmal subarachnoid hemorrhage. However, the impact of the low-grade inflammation (LGI) score, which can reflect the synergistic effects of five individual inflammatory biomarkers on SCVS and poor functional outcome on aneurysmal subarachnoid hemorrhage (aSAH), has not yet been well established. The aim of this study was to evaluate the impact of the LGI score on SCVS and poor functional outcome in aSAH patients. METHODS The LGI score was calculated as the sum of 10 quantiles of each individual inflammatory biomarker. The association of the LGI score with the risk of SCVS and poor functional outcome was analyzed with multivariate logistical regression. RESULTS A total of 270 eligible aSAH patients were included in this study: 74 (27.4%) had SCVS, and 79 (29.3%) had poor functional outcomes. After adjusting for confounders, a higher LGI score was revealed to independently predict SCVS (OR, 1.083; 95% CI, 1.011-1.161; P = 0.024) and poor functional outcome (OR, 1.132; 95% CI, 1.023-1.252; P = 0.016), and the second and third tertile group had higher risk of SCVS than lowest tertile group (OR, 2.826; 95% CI, 1.090-7.327; P = 0.033) (OR, 3.243; 95% CI, 1.258-8.358; P = 0.015). The receiver operating characteristic (ROC) curve uncovered the ability of the LGI score to distinguish patients with and without SCVS (area under the curve [AUC] = 0.746; 95% CI, 0.690-0.797; P < 0.001) and poor functional outcomes (area under the curve [AUC] = 0.799; 95% CI, 0.746-0.845; P < 0.001), the predictive value of LGI on SCVS and poor functional outcome is superior than PLT, NLR and WBC, but there was no statistical difference between LGI and CRP for predicting SCVS (P = 0.567) and poor functional outcome (P = 0.171). CONCLUSIONS A higher LGI which represents severe low grade inflammation status is associated with SCVS and poor functional outcome at 3 months after aSAH.
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Affiliation(s)
- Ling Wang
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Jin
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Xiangyang Cao
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Liujun Xue
- Department of Neurology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Qiantao Cheng
- Department of Neurology, Huai' an 82 hospital, Huaian, Jiangsu, China.
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12
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Ishikawa T, Ikawa F, Ichihara N, Yamaguchi K, Funatsu T, Nakatomi H, Shiokawa Y, Sorimachi T, Murayama Y, Suzuki K, Kurita H, Fukuda H, Ueba T, Shimamura N, Ohkuma H, Morioka J, Nakahara I, Uezato M, Chin M, Kawamata T. Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-Grade Subarachnoid Hemorrhage: A Registry Study in Japan. Neurosurgery 2023:00006123-990000000-00980. [PMID: 38038438 DOI: 10.1227/neu.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The differences in clinical outcomes between endovascular coiling (EC) and surgical clipping (SC) in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) are controversial. Therefore, this study aimed to evaluate whether EC is superior to SC and identify risk factors in patients with poor-grade aSAH. METHODS We used data from the "Predict for Outcome Study of aneurysmal SubArachnoid Hemorrhage." World Federation of Neurological Societies (WFNS) grade III-V aSAH was defined as poor-grade aSAH, and unfavorable clinical outcomes (modified Rankin Scale scores 3-6) were compared between SC and EC after propensity score matching (PSM). In-hospital mortality was similarly evaluated. Predictors of unfavorable clinical outcomes were identified using multivariable analysis. RESULTS Ultimately, 1326 (SC: 847, EC: 479) and 632 (SC: 316, EC: 316) patients with poor-grade aSAH were included before and after PSM, respectively. Unfavorable clinical outcomes at discharge were significantly different between SC and EC before (72.0% vs 66.2%, P = .026) and after PSM (70.6% vs 63.3%, P = .025). In-hospital mortality was significantly different between groups before PSM (10.5% vs 16.1%, P = .003) but not after PSM (10.4% vs 12.7%, P = .384). Predictors of unfavorable clinical outcomes in both SC and EC were WFNS grade V, older than 70 years, and Fisher computed tomography (CT) grade 4. Predictors of unfavorable clinical outcomes only in SC were WFNS grade IV (odds ratio: 2.46, 95% CI: 1.22-4.97, P = .012) and Fisher CT grade 3 (4.90, 1.42-16.9, P = .012). Predictors of unfavorable clinical outcome only in EC were ages of 50s (3.35, 1.37-8.20, P = .008) and 60s (3.28, 1.43-7.52, P = .005). CONCLUSION EC resulted in significantly more favorable clinical outcomes than SC in patients with poor-grade aSAH, without clear differences in in-hospital mortality. The benefit of EC over SC might be particularly remarkable in patients with WFNS grade IV and Fisher CT grade 3.
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Affiliation(s)
- Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
- Department of Cardiovascular Surgery, Jikei University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Takayuki Funatsu
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | | | | | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Norihito Shimamura
- Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan
- Department of Neurosurgery, Hirosaki General Medical Center, National Hospital Organization, Hirosaki, Aomori, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan
- Department of Neurosurgery, Hirosaki General Medical Center, National Hospital Organization, Hirosaki, Aomori, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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13
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Liao B, Xu Q, Lu P, Zhang Y. The prognostic value of systemic immune-inflammation index in patients with aneurysmal subarachnoid hemorrhage: a systematic review. Neurosurg Rev 2023; 46:219. [PMID: 37659015 DOI: 10.1007/s10143-023-02133-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating and life-threatening stroke subtype, that has a high disability and fatality rate. By the use of the systemic immune-inflammation index (SII), it is possible to understand the pathophysiology that underlies immune and inflammatory responses and anticipate consequences including delayed cerebral ischemia (DCI), delayed cerebral vasospasm, and functional outcome. A systematic search of the English-language literature in PubMed and Embase was performed to locate articles addressing the usage of SII in aSAH patients. The cutoff value, sensitivity, specificity, and area-under-the curve (AUC) of the receiver operating characteristic (ROC) curve were collected. Four publications were reviewed after applying the exclusion criteria from the 53 included articles. All the studies indicated that higher SII on admission was significantly associated with poor prognosis. The research examined in this paper provides the earliest indications that higher SII predicts DCI, delayed cerebral vasospasm, and functional outcome, even though other medical subspecialties have used this ratio for a long time to make such predictions.
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Affiliation(s)
- Bingyao Liao
- Department of Emergency, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, China
| | - Qingyu Xu
- Department of Neurosurgery, Sichuan Science City Hospital, Mianyang, 621000, Sichuan, China
| | - Peng Lu
- Department of Neurosurgery, Sichuan Science City Hospital, Mianyang, 621000, Sichuan, China
| | - Yunxia Zhang
- Department of Geriatric, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, Sichuan, China.
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14
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Lukito PP, Lie H, Angelica V, Wijovi F, Nathania R, July J. Red-cell distribution width as a prognostic marker for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis. World Neurosurg X 2023; 19:100202. [PMID: 37181583 PMCID: PMC10172754 DOI: 10.1016/j.wnsx.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023] Open
Affiliation(s)
- Patrick P. Lukito
- Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
- Corresponding author.
| | - Hendry Lie
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Vanessa Angelica
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Felix Wijovi
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Regina Nathania
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Julius July
- Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
- Corresponding author.
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15
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Siddiqi MM, Khawar WI, Donnelly BM, Lim J, Kuo CC, Monteiro A, Baig AA, Waqas M, Soliman MAR, Davies JM, Snyder KV, Levy EI, Siddiqui AH, Vakharia K. Pretreatment and Posttreatment Factors Associated with Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 175:e925-e939. [PMID: 37075897 DOI: 10.1016/j.wneu.2023.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to evaluate novel preoperative and postoperative risk factors for shunt-dependent hydrocephalus (SDHC) after aSAH via a systematic review and meta-analysis. METHODS A systematic search was conducted using PubMed and Embase databases for studies pertaining to aSAH and SDHC. Articles were assessed by meta-analysis if the number of risk factors for SDHC was reported by >4 studies and could be extracted separately for patients who did or did not develop SDHC. RESULTS Thirty-seven studies were included, comprising 12,667 patients with aSAH (SDHC 2214 vs. non-SDHC 10,453). In a primary analysis of 15 novel potential risk factors, 8 were identified to be significantly associated with increased prevalence of SDHC after aSAH, including high World Federation of Neurological Surgeons grades (odds ratio [OR], 2.43), hypertension (OR, 1.33), anterior cerebral artery (OR, 1.36), middle cerebral artery (OR, 0.65), and vertebrobasilar artery (2.21) involvement, decompressive craniectomy (OR, 3.27), delayed cerebral ischemia (OR, 1.65), and intracerebral hematoma (OR, 3.91). CONCLUSIONS Several new factors associated with increased odds of developing SDHC after aSAH were found to be significant. By providing evidence-based risk factors for shunt dependency, we describe an identifiable list of preoperative and postoperative prognosticators that may influence how surgeons recognize, treat, and manage patients with aSAH at high risk for developing SDHC.
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Affiliation(s)
- Manhal M Siddiqi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
| | - Wasiq I Khawar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Mohammed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
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16
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Azeem S, Ashraf M, Kamboh UA, Raza MA, Farooq M, Cheema HA, Tariq S, Choudhary N, Hussain SS, Ashraf N. Association of ABO Blood Group with Delayed Cerebral Ischemia and Clinical Outcomes Following Aneurysmal Subarachnoid Hemorrhage in Pakistan. Asian J Neurosurg 2023; 18:108-116. [PMID: 37056873 PMCID: PMC10089742 DOI: 10.1055/s-0043-1760859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background The ABO blood type, due to its various hemostaseologic properties, has been associated with several vascular diseases, including aneurysmal subarachnoid hemorrhage (aSAH). However, the role of ABO blood type in delayed cerebral ischemia (DCI) onset and other clinical outcomes after aSAH is largely unexplored. This study aimed to investigate the association between ABO blood type and outcomes after aSAH, primarily DCI.
Methods A retrospective analysis was made on the data collected from 175 aSAH patients at a tertiary supraregional neurosurgery department over 5 years. Socio-demographic factors, clinical variables (DCI, mFG, WFNS grade, and Glasgow Outcome Scale at discharge), EVD placement, and aneurysm size were analyzed for their association with ABO blood type.
Results DCI was reported in 25% of patients with ‘O’ blood type and 9.6% with ‘non-O’ blood type. A stepwise logistic regression model showed that after adjusting for BMI, mFG, WFNS grade, and EVD placement, ‘O’ type blood group was an independent risk factor for DCI, greatly increasing the risk of DCI as compared to ‘non-O’ type groups (OR = 3.27, 95% CI: 1.21–8.82).
Conclusion This study provides evidence that individuals with ‘O’ blood type may have a higher risk of DCI onset after aSAH. However, further studies are essential to address the limitations of our work and confirm our findings.
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Affiliation(s)
- Saleha Azeem
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Minaam Farooq
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Simra Tariq
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
- Department of Neurosurgery, Gujranwala Medical College, Gujranwala, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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17
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The D-Dimer/Albumin Ratio Is a Prognostic Marker for Aneurysmal Subarachnoid Hemorrhage. Brain Sci 2022; 12:brainsci12121700. [PMID: 36552160 PMCID: PMC9775718 DOI: 10.3390/brainsci12121700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurological event with limited treatment options, and little is known about its pathophysiology. There are few objective tools for predicting outcomes of aSAH patients and further aiding in directing clinical therapeutic programs. This study aimed to determine whether an elevated serum D-dimer/albumin ratio (DAR) reflects disease severity and predicts aSAH outcomes. Methods: We included 178 patients with aSAH. Data included demographics; clinical severity of aSAH (World Federation of Neurological Societies (WFNS) grade and Hunt-Hess grade); levels of D-dimer, albumin, and c-reactive protein (CRP); leukocyte counts on admission; and three-month outcomes. The outcomes were dichotomized into good and poor. The predictive ability of DAR for outcomes was determined using receiver operating characteristic (ROC) curve analysis. Results: Serum DAR showed a positive correlation with disease severity. Univariate analysis revealed that DAR, WFNS grade, Hunt-Hess grade, delayed cerebral infarction (DCI), age, neutrophil-to-lymphocyte ratio (NLR), and CRP/albumin ratio (CAR) were associated with unfavorable outcomes. Multivariate regression analysis further revealed that elevated DAR predicted poor outcomes after adjusting for WFNS grade, Hunt-Hess grade, DCI, age, NLR, and CRP/albumin ratio. Receiver operating characteristic curve analysis revealed that DAR predicted outcomes at a level comparable with NLR and CAR and had superior predictivity than D-dimer alone. Conclusion: DAR is a promising objective tool for aSAH outcome prediction. A high content DAR was associated with disease severity and unfavorable short-term outcomes.
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18
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Tsyben A, Guilfoyle MR, Laing RJC, Timofeev I, Anwar F, Trivedi RA, Kirollos RW, Turner C, Allanson J, Mee H, Outtrim JG, Menon DK, Hutchinson PJA, Helmy A. Comparison of health-related quality of life in patients with traumatic brain injury, subarachnoid haemorrhage and cervical spine disease. Br J Neurosurg 2022:1-7. [PMID: 36495241 DOI: 10.1080/02688697.2022.2152777] [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: 08/03/2021] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The degree of disability that is acceptable to patients following traumatic brain injury (TBI) continues to be debated. While the dichotomization of outcome on the Glasgow Outcome Score (GOSE) into 'favourable' and 'unfavourable' continues to guide clinical decisions, this may not reflect an individual's subjective experience. The aim of this study is to assess how patients' self-reported quality of life (QoL) relates to objective outcome assessments and how it compares to other debilitating neurosurgical pathologies, including subarachnoid haemorrhage (SAH) and cervical myelopathy. METHOD A retrospective analysis of over 1300 patients seen in Addenbrooke's Hospital, Cambridge, UK with TBI, SAH and patients pre- and post- cervical surgery was performed. QoL was assessed using the SF-36 questionnaire. Kruskal-Wallis test was used to analyse the difference in SF-36 domain scores between the four unpaired patient groups. To determine how the point of dichotomization of GOSE into 'favourable' and 'unfavourable' outcome affected QOL, SF-36 scores were compared between GOSE and mRS. RESULTS There was a statistically significant difference in the median Physical Component Score (PCS) and Mental Component Score (MCS) of SF-36 between the three neurosurgical pathologies. Patients with TBI and SAH scored higher on most SF-36 domains when compared with cervical myelopathy patients in the severe category. While patients with Upper Severe Disability on GOSE showed significantly higher PC and MC scores compared to GOSE 3, there was a significant degree of variability in individual responses across the groups. CONCLUSION A significant number of patients following TBI and SAH have better self-reported QOL than cervical spine patients and patients' subjective perception and expectations following injury do not always correspond to objective disability. These results can guide discussion of treatment and outcomes with patients and families.
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Affiliation(s)
- Anastasia Tsyben
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Mathew R Guilfoyle
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Rodney J C Laing
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Fahim Anwar
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Rikin A Trivedi
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | | | - Carole Turner
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Judith Allanson
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Harry Mee
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Joanne G Outtrim
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - David K Menon
- Neurocritical Care Unit & University Department of Anaesthesia, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Peter J A Hutchinson
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Adel Helmy
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
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19
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Shah VA, Kazmi SO, Damani R, Harris AH, Hohmann SF, Calvillo E, Suarez JI. Regional Variability in the Care and Outcomes of Subarachnoid Hemorrhage Patients in the United States. Front Neurol 2022; 13:908609. [PMID: 35785364 PMCID: PMC9243235 DOI: 10.3389/fneur.2022.908609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Regional variability in subarachnoid hemorrhage (SAH) care is reported in physician surveys. We aimed to describe variability in SAH care using patient-level data and identify factors impacting hospital outcomes and regional variability in outcomes. Methods A retrospective multi-center cross-sectional cohort study of consecutive non-traumatic SAH patients in the Vizient Clinical Data Base, between January 1st, 2009 and December 30th, 2018 was performed. Participating hospitals were divided into US regions: Northeast, Midwest, South, West. Regional demographics, co-morbidities, severity-of-illness, complications, interventions and discharge outcomes were compared. Multivariable logistic regression was performed to identify factors independently associated with primary outcomes: hospital mortality and poor discharge outcome. Poor discharge outcome was defined by the Nationwide Inpatient Sample-SAH Outcome Measure, an externally-validated outcome measure combining death, discharge disposition, tracheostomy and/or gastrostomy. Regional variability in the associations between care and outcomes were assessed by introducing an interaction term for US region into the models. Results Of 109,034 patients included, 24.3% were from Northeast, 24.9% Midwest, 34.9% South, 15.9% West. Mean (SD) age was 58.6 (15.6) years and 64,245 (58.9%) were female. In-hospital mortality occurred in 21,991 (20.2%) and 44,159 (40.5%) had poor discharge outcome. There was significant variability in severity-of-illness, co-morbidities, complications and interventions across US regions. Notable findings were higher prevalence of surgical clipping (18.8 vs. 11.6%), delayed cerebral ischemia (4.3 vs. 3.1%), seizures (16.5 vs. 14.8%), infections (18 vs. 14.7%), length of stay (mean [SD] days; 15.7 [19.2] vs. 14.1 [16.7]) and health-care direct costs (mean [SD] USD; 80,379 [98,999]. vs. 58,264 [74,430]) in the West when compared to other regions (all p < 0.0001). Variability in care was also associated with modest variability in hospital mortality and discharge outcome. Aneurysm repair, nimodipine use, later admission-year, endovascular rescue therapies reduced the odds for poor outcome. Age, severity-of-illness, co-morbidities, hospital complications, and vasopressor use increased those odds (c-statistic; mortality: 0.77; discharge outcome: 0.81). Regional interaction effect was significant for admission severity-of-illness, aneurysm-repair and nimodipine-use. Discussion Multiple hospital-care factors impact SAH outcomes and significant variability in hospital-care and modest variability in discharge-outcomes exists across the US. Variability in SAH-severity, nimodipine-use and aneurysm-repair may drive variability in outcomes.
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Affiliation(s)
- Vishank A. Shah
- Division of Neurosciences Critical Care, Department of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Vishank A. Shah
| | | | - Rahul Damani
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Alyssa Hartsell Harris
- Center for Advanced Analytics and Informatics, Vizient, Inc., Chicago, IL, United States
| | - Samuel F. Hohmann
- Center for Advanced Analytics and Informatics, Vizient, Inc., Chicago, IL, United States
| | - Eusebia Calvillo
- Division of Neurosciences Critical Care, Department of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jose I. Suarez
- Division of Neurosciences Critical Care, Department of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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20
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Chen SJ, Chen LD. Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_237_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Shi M, Yang C, Tang QW, Xiao LF, Chen ZH, Zhao WY. The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies. Front Neurol 2021; 12:745560. [PMID: 34867727 PMCID: PMC8636120 DOI: 10.3389/fneur.2021.745560] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/12/2021] [Indexed: 12/26/2022] Open
Abstract
The neutrophil–to-lymphocyte ratio (NLR), as an essential systemic inflammation factor, has been widely used as a prognostic indicator in various diseases, such as malignant tumors, cardiovascular disease, and intracranial hemorrhage. An increasing number of studies have believed that NLR is a valuable predictor of prognosis for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, these results remain controversial. In the current study, we planned to carry out a systematic review and meta-analysis to investigate the association between NLR and poor outcome, and the occurrence of delayed cerebral ischemia (DCI). We carried out a comprehensive search for published literatures on PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to April 1, 2021. We conducted an assessment of all included studies based on the principles proposed in the Newcastle-Ottawa Quality Assessment Scale (NOS). Poor outcome and the occurrence of DCI were considered as the main outcome measure. We calculated the pooled odds ratio (OR) and corresponding 95% confidence interval (CI) to examine the strength of the association of NLR with poor outcome or the occurrence of DCI. We strictly selected a total of 10 studies comprising 4,989 patients. Nine studies reported the association between NLR and poor outcome, and five studies reported the association between NLR and the occurrence of DCI. The pooled results indicated higher NLR was significantly associated with both poorer outcomes (OR = 1.32, 95%CI 1.11–1.57; P = 0.002, I2 = 87%), and the occurrence of DCI (OR = 1.72, 95%CI 1.22–2.41; P = 0.002, I2 = 82%) in aSAH patients. The NLR is a valuable indicator of inflammation to independently predict poor outcome and occurrence of DCI after aSAH, where a higher NLR is significantly associated with poor outcomes and occurrence of DCI. These findings suggest that the NLR can help clinicians evaluate the prognosis and identify potentially severe patients early, which may contribute to better management and improve poor prognosis of aSAH patients.
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Affiliation(s)
- Min Shi
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qing-Wen Tang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ling-Fei Xiao
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zu-Han Chen
- Institute of Hepatobiliary Diseases of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-Yuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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22
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Bian L, Lin J, Liu Y, Lu J, Zhao X. Copeptin and insulin-like growth factor-1 predict long-term outcomes after aneurysmal subarachnoid hemorrhage: A large prospective cohort study. Clin Neurol Neurosurg 2021; 209:106863. [PMID: 34474332 DOI: 10.1016/j.clineuro.2021.106863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The predictive roles of copeptin and insulin-like growth factor-1 (IGF-1) in aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. We aimed to define the relationship between copeptin and IGF-1 levels and functional outcome as well as quality of life (QoL) after aSAH. METHODS Patients with aSAH were prospectively enrolled in a tertiary university hospital. Controls were sex- and age-matched healthy subjects. Plasma concentrations of copeptin and IGF-1 were measured on admission. Demographics and clinical, radiological and laboratory characteristics of the patients were collected. Favorable functional outcome was defined as modified Rankins≤2, and QoL was evaluated by the 36-Item Short Form Health Survey (SF-36) 1 year after aSAH. Uni- and multivariable analyses were performed. RESULTS One hundred eighteen patients were eligible, with 122 healthy controls were included in this study. Plasma copeptin levels were significantly higher and plasma IGF-1 was lower in patients than in controls. Both copeptin (adjusted HR 4.143 [1.120-15.328], p = 0.033) and IGF-1 levels (adjusted HR 0.089 [0.013-0.602], p = 0.013) were positively associated with 1-year mortality, while only single copeptin and IGF-1 concentrations were independent predictors of poor functional outcome and QoL, respectively. CONCLUSIONS Plasma copeptin and IGF-1 levels are abnormal in patients with acute aSAH, and this may reliably predict long-term mortality, functional outcome and QoL.
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Affiliation(s)
- Liheng Bian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingjing Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
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23
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Perry A, Graffeo CS, Kleinstern G, Carlstrom LP, Link MJ, Rabinstein AA. Quantitative Modeling of External Ventricular Drain Output to Predict Shunt Dependency in Aneurysmal Subarachnoid Hemorrhage: Cohort Study. Neurocrit Care 2021; 33:218-229. [PMID: 31820290 DOI: 10.1007/s12028-019-00886-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal. METHODS Cohort study of aSAH is treated with external ventricular drainage (EVD) placement at our institution, 2001-2016, via logistic regression. EVD-related parameters included mean/total EVD output (days 0-2), EVD days, EVD days ≤ 5 mmHg, and wean/clamp fails. aSAH outcomes assessed included ventriculoperitoneal shunt (VPS) placement, delayed cerebral ischemia (DCI), radiographic infarction (RI), symptomatic vasospasm (SV), age, and aSAH grades. RESULTS Two hundred and ten aSAH patients underwent EVD treatment for a median 12 days (range 1-54); 85 required VPS (40%). On univariate analysis, EVD output, total EVD days, EVD days ≤ 5 mmHg, and wean/clamp trial failures were significantly associated with VPS placement (p < 0.01 for all parameters). No EVD output parameter demonstrated a significant association with DCI, RI, or SV. On multivariate analysis, EVD output was a significant predictor of VPS placement, after adjusting for age and clinical and radiological grades; the optimal threshold for predicting VPS placement was mean daily output > 204 ml on days 0-2 (OR 2.59, 95% CI 1.31-5.07). Multiple wean failures were associated with unfavorable functional outcome, after adjusting for age, grade, and VPS placement (OR 1.65, 95% CI 1.10-2.47). We developed a score incorporating age, grade and EVD parameters (MAGE) for predicting VPS placement after aSAH. CONCLUSIONS EVD output parameters and wean/clamp trial failures predicted shunt dependence in an age- and grade-adjusted multivariable model. Early VPS placement may be warranted in patients with MAGE score ≥ 4, particularly following 2 failed wean trials.
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Affiliation(s)
- A Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - C S Graffeo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - G Kleinstern
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - L P Carlstrom
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - M J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - A A Rabinstein
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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24
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Monteiro A, Lazar AL, Waqas M, Rai HH, Baig AA, Cortez GM, Dossani RH, Cappuzzo JM, Levy EI, Siddiqui AH. Treatment of ruptured intracranial aneurysms with the Woven EndoBridge device: a systematic review. J Neurointerv Surg 2021; 14:366-370. [PMID: 34266907 DOI: 10.1136/neurintsurg-2021-017613] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/28/2021] [Indexed: 11/04/2022]
Abstract
The Woven EndoBridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the aneurysm's parent vessel lumen obviates the need for potent antiplatelet therapy, making this device appealing for acutely ruptured aneurysms not amenable to clipping or coiling. To assess the literature regarding WEB treatment of these aneurysms, we performed a comprehensive systematic search of PubMed, MEDLINE, and EMBASE databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were combined with Boolean operators to increase search sensitivity and specificity ('woven endobridge device' AND 'ruptured'). Nine studies comprising 377 acutely ruptured aneurysms were included. Overall, 82.7% were wide-necked, 85.9% were located in the anterior circulation, and 26.9% of patients presented with poor subarachnoid hemorrhage grade. Intraprocedure and postprocedure complications occurred in 8.4% (95% CI 3.6% to 13.3%) and 1% (95% CI 0% to 2%), respectively. The post-treatment rebleeding rate was 0%. Rates of adequate occlusion (complete occlusion to neck remnant) and retreatment at last follow-up were 84.8% (95% CI 73% to 96.6%) and 4.5% (95% CI 2.2% to 6.8%), respectively. The favorable outcome rate (modified Rankin Scale score 0-2) was 62.2% (95% CI 53% to 71.4%); mortality was 13.6% (95% CI 9.7% to 17.6%). WEB treatment of acutely ruptured aneurysms results in high adequate occlusion rates, low perioperative complication rates, no rebleeding, and low recurrence requiring retreatment. This device is promising for acutely ruptured aneurysms not amenable to clipping or coiling, considering the lower need for antiplatelet regimens during the procedure or follow-up.
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Affiliation(s)
- Andre Monteiro
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Audrey L Lazar
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Hamid H Rai
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Ammad A Baig
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | | | - Rimal H Dossani
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA .,Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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25
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de Jong G, Aquarius R, Sanaan B, Bartels RHMA, Grotenhuis JA, Henssen DJHA, Boogaarts HD. Prediction Models in Aneurysmal Subarachnoid Hemorrhage: Forecasting Clinical Outcome With Artificial Intelligence. Neurosurgery 2021; 88:E427-E434. [PMID: 33548918 DOI: 10.1093/neuros/nyaa581] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Predicting outcome after aneurysmal subarachnoid hemorrhage (aSAH) is known to be challenging and complex. Machine learning approaches, of which feedforward artificial neural networks (ffANNs) are the most widely used, could contribute to the patient-specific outcome prediction. OBJECTIVE To investigate the prediction capacity of an ffANN for the patient-specific clinical outcome and the occurrence of delayed cerebral ischemia (DCI) and compare those results with the predictions of 2 internationally used scoring systems. METHODS A prospective database was used to predict (1) death during hospitalization (ie, mortality) (n = 451), (2) unfavorable modified Rankin Scale (mRS) at 6 mo (n = 413), and (3) the occurrence of DCI (n = 362). Additionally, the predictive capacities of the ffANN were compared to those of Subarachnoid Haemorrhage International Trialists (SAHIT) and VASOGRADE to predict clinical outcome and occurrence of DCI. RESULTS The area under the curve (AUC) of the ffANN showed to be 88%, 85%, and 72% for predicting mortality, an unfavorable mRS, and the occurrence of DCI, respectively. Sensitivity/specificity rates of the ffANN for mortality, unfavorable mRS, and the occurrence of DCI were 82%/80%, 94%/80%, and 74%/68%. The ffANN and SAHIT calculator showed similar AUCs for predicting personalized outcome. The presented ffANN and VASOGRADE were found to perform equally with regard to personalized prediction of occurrence of DCI. CONCLUSION The presented ffANN showed equal performance when compared with VASOGRADE and SAHIT scoring systems while using less individual cases. The web interface launched simultaneously with the publication of this manuscript allows for usage of the ffANN-based prediction tool for individual data (https://nutshell-tool.com/).
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Affiliation(s)
- Guido de Jong
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René Aquarius
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Barof Sanaan
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J André Grotenhuis
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dylan J H A Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Mahta A, Murray K, Reznik ME, Thompson BB, Wendell LC, Furie KL. Early Neurological Changes and Interpretation of Clinical Grades in Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2021; 30:105939. [PMID: 34171650 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105939] [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: 04/16/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Hunt and Hess (HH) and World Federation of Neurological Surgeons (WFNS) grades are commonly used to report clinical severity of aneurysmal subarachnoid hemorrhage (aSAH). We sought to determine the impact of early neurological changes and the timing of clinical grade assignment on the prognostication accuracy. METHODS We retrospectively reviewed a cohort of consecutive patients with aSAH who were admitted to an academic center. Patients with confirmed aneurysmal cause were included. Relevant clinical data including daily clinical grades, imaging data and functional outcome were analyzed. Favorable outcome was defined as mRS 0 to 3. Early neurological improvement (ENI) and early neurological deterioration (END) were respectively defined as any improvement or deterioration of HH grades from hospital day 1 to the earliest time from hospital day 2 to 5. RESULTS Of 310 patients, 24% experienced early neurological changes from hospital day 1 to 3. For each point increase in HH grades from day 1 to day 3, the odds ratio for worse outcome was 2.57 (95% CI [1.74-3.79]) and for each point decrease in HH grades from day 1 to day 3, the odds ratio for worse outcome was 0.28 (95% CI [0.17-0.47]). Receiver Operating Characteristic curve analysis revealed that clinical grades on day 3 had higher accuracy in predicting worse outcome than clinical grades on day 1. CONCLUSION Early changes in neurological status can alter trajectory of hospital course and functional outcome. The prognostic accuracy of the clinical grades from hospital day 3 is significantly greater than those on admission.
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Affiliation(s)
- Ali Mahta
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Kayleigh Murray
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael E Reznik
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Bradford B Thompson
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Linda C Wendell
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Wang G, Liang XS, He CJ, Zhou YF, Chen SH. Ability of serum annexin A1 to predict 6-month poor clinical outcome following aneurysmal subarachnoid hemorrhage. Clin Chim Acta 2021; 519:142-147. [PMID: 33932407 DOI: 10.1016/j.cca.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Annexin A1 might be neuroprotective and serum annexin A1 concentrations were markedly declined after severe traumatic brain injury. We determine dthe ability of serum annexin A1 to assess severity and predict prognosis after aneurysmal subarachnoid hemorrhage (aSAH). METHODS We included 157 aSAH patients and 157 healthy subjects. Serum annexin A1 measurements were measured. A poor outcome was designated as Glasgow outcome scale score of 1-3. Multivariate logistic regression analysis was applied to identify predictors of a poor 6-month outcome. RESULTS Serum annexin A1 concentrations were significantly lower in patients than in controls. Annexin A1 concentrations were strongly correlated with the World Federation of Neurological Surgeons scale (WFNS) score, Hunt-Hess score, Glasgow coma scale score and modified Fisher score. A total of 59 patients (37.6%) experienced a poor outcome. Serum annexin A1, WFNS score and modified Fisher score emerged as the 3 independent predictors for a poor outcome after aSAH. Under ROC curve analysis, serum annexin A1 had a fair accuracy to predict a poor outcome, AUC of serum annexin A1 concentration was equivalent to those of WFNS score and modified Fisher score and AUC of combination of the 3 factors significantly exceeded that of each one alone. CONCLUSIONS Annexin A1 may be involved in the occurrence and progression of secondary brain injury after aSAH. Detection of serum annexin A1 may have certain ability for assessment of severity and prediction of long-term prognosis following aSAH.
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Affiliation(s)
- Gang Wang
- Department of Neurosurgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 North Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
| | - Xiao-Song Liang
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China.
| | - Chen-Jun He
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
| | - Yi-Fu Zhou
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
| | - Si-Hua Chen
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
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Fang Y, Lu J, Zheng J, Wu H, Araujo C, Reis C, Lenahan C, Zhu S, Chen S, Zhang J. Comparison of aneurysmal subarachnoid hemorrhage grading scores in patients with aneurysm clipping and coiling. Sci Rep 2020; 10:9199. [PMID: 32513925 PMCID: PMC7280262 DOI: 10.1038/s41598-020-66160-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/13/2020] [Indexed: 11/28/2022] Open
Abstract
Past studies revealed the prognosis differed between aneurysmal subarachnoid hemorrhage (aSAH) patients with surgical clipping and endovascular coiling. We retrospectively reviewed aSAH patients in our institution to investigate the effectiveness of grading scores between two groups. In the surgical clipping group (n = 349), VASOGRADE had a favorable performance for predicting delayed cerebral ischemia (DCI) (area under curve (AUC) > 0.750), and had better results than clinical (World Federation of Neurosurgical Societies (WFNS), Hunt & Hess (HH) and radiological scores (modified Fisher Scale (mFS), Subarachnoid Hemorrhage Early Brain Edema Score) (P < 0.05). Clinical and combined scores (VASOGRADE, HAIR) had favorable performance for predicting poor outcome (AUC > 0.750), and had better results than radiological scores (P < 0.05). In the coiling group (n = 320), none of the grading scores demonstrated favorable predictive accuracy for DCI (AUC < 0.750). Only WFNS and VASOGRADE had AUC > 0.700, with better performance than mFS (P < 0.05). The clinical and combined scores showed favorable performance for predicting a poor outcome (AUC > 0.750), and were better than the radiological scores (P < 0.05). Radiological scores appeared inferior to the clinical and combined scores in clipping and coiling groups. VASOGRADE can be an effective grading score in patients with clipping or coiling for predicting DCI and poor outcome.
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Affiliation(s)
- Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianan Lu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingwei Zheng
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haijian Wu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Camila Araujo
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Cesar Reis
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Cameron Lenahan
- Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Suijun Zhu
- Department of Neurosurgery, First People's Hospital of Yuhang District, Hangzhou, Zhejiang, China
| | - Sheng Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China.
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.
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Dhandapani S, Singh A, Singla N, Praneeth K, Aggarwal A, Sodhi HB, Pal SS, Goudihalli S, Salunke P, Mohindra S, Kumar A, Gupta V, Chhabra R, Mukherjee KK, Tewari MK, Khandelwal N, Mathuriya SN, Khosla VK, Gupta SK. Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services? Stroke 2019; 49:2890-2895. [PMID: 30571395 DOI: 10.1161/strokeaha.118.022865] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose- Though reports suggest decreasing fatality rates of subarachnoid hemorrhage with time, trends in outcome are not reported much especially from developing countries. This study was to analyze changes in outcome across 2 decades and elucidate probable factors. Methods- Prospective databases during 1996 to 2015 were reviewed for neurological outcome at 3 months in relation to demographics, Hunt and Hess grade, Fisher grade, and definitive treatment; and compared between 2 decades, contrasted by establishment of intensive care unit with continuous monitoring and other advancements. Univariate and multivariate analyses were performed. Results- Of the total 2039 patients, 1035 were managed in the former and 1004 in the recent decades. Compared with the former decade, there is delayed age at presentation (46 versus 49 years, P<0.001), poorer Fisher grades (81% versus 87%, P<0.001), and more patients with Hunt and Hess grade 2 (24% versus 39%, P<0.001) in the recent decade. While all patients in databases of the former decade had undergone clipping, 6% in the recent decade underwent coiling. 11% in the recent decade could not undergo definitive treatment. Despite this, there was significantly higher overall favorable outcome (50% versus 60%; odds ratio, 1.5; P<0.001) in recent decade. Favorable outcome of surgical clipping per se improved significantly from 50% to 67% (odds ratio 2.0; P<0.001). Though the improvement was across subgroups, it was more marked among Hunt and Hess grade 3 and Fisher grades 3 and 4. In multivariate analyses, both overall outcome (adjusted odds ratio, 1.7; 95% CI, 1.4-2.1; P<0.001) and surgical outcome (adjusted odds ratio, 1.8; 95% CI, 1.5-2.2; P<0.001) were significantly better in recent decade, independent of known prognostic factors. Conclusions- This is probably the first report to show independent improvement in outcome of subarachnoid hemorrhage with betterment in neurosurgical services from developing country. Dedicated intensive care unit care and focused management protocols could be the likely causes for improvement. Resource-constrained institutions may target patients in Hunt and Hess grade 3 and Fisher grades 3 and 4 for optimal intensive care unit utilization.
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Affiliation(s)
- Sivashanmugam Dhandapani
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Apinderpreet Singh
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Navneet Singla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kokkula Praneeth
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashish Aggarwal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Harsimrat B Sodhi
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sudhir S Pal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sachin Goudihalli
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sandeep Mohindra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ajay Kumar
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vivek Gupta
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Chhabra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanchan K Mukherjee
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Manoj K Tewari
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Suresh N Mathuriya
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Virender K Khosla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sunil K Gupta
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Dhandapani S. eNOS: A Passing Fad or the Crux of the Panacea? Neurol India 2019; 67:1013-1014. [PMID: 31512623 DOI: 10.4103/0028-3886.266243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shikata E, Tamura T, Shinno K, Okayama Y, Shinohara N, Shimada K, Kanematsu Y, Kitazato KT, Nagahiro S, Takagi Y. Importance of Managing the Water-Electrolyte Balance by Delivering the Optimal Minimum Amount of Water and Sodium After Subarachnoid Hemorrhage. World Neurosurg 2019; 129:e352-e360. [PMID: 31132492 DOI: 10.1016/j.wneu.2019.05.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND After aneurysmal subarachnoid hemorrhage (aSAH), crystalloid fluids with a relatively high sodium concentration have been used to maintain the cerebral blood flow. However, the prophylactic delivery of water and sodium by intravenous (IV) infusion will not necessarily improve the prognosis of patients after aSAH, and the excessive supply of water and sodium can negatively affect the outcome. We hypothesized that the delivery of an optimal amount of water and sodium separately might improve the outcome after aSAH. METHODS We recruited 55 consecutive patients who had undergone clipping or endovascular coil embolization after aSAH. Group 1 (n = 33) received conventional therapy (i.e., prophylactic IV sodium and water [protocol 1]). Group 2 (n = 22) received the optimal amount of water and sodium separately (protocol 2). RESULTS The median total of water and sodium chloride supplied in group 1 was significantly greater than that supplied in group 2 (P < 0.01). The modified Rankin scale score at discharge was 0-2 in 15 patients (95%) in group 2 and 23 patients (55%) in group 1 (P < 0.001). On multivariate logistic regression analysis, the odds ratio for a discharge modified Rankin scale score of 0-2 or 3-6 was significantly associated with the treatment protocol (P < 0.05) and the net fluid balance on days 4-8 (P < 0.05). CONCLUSION The separate delivery of optimal amounts of water and sodium could be a promising therapeutic strategy to improve the prognosis after aSAH.
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Affiliation(s)
- Eiji Shikata
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan.
| | - Tetsuya Tamura
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kiyohito Shinno
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Yoshihiro Okayama
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Naoki Shinohara
- Department of Neurosurgery, HITO Medical Center, Ehime, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan
| | - Keiko T Kitazato
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan
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Singh A, Dhandapani S. Response by Singh and Dhandapani to Letter Regarding Article, “Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services?: Study of 2000 Patients Over 2 Decades From India”. Stroke 2019; 50:e113. [DOI: 10.1161/strokeaha.119.024451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ding CY, Cai HP, Ge HL, Yu LH, Lin YX, Kang DZ. Is Admission Lipoprotein-Associated Phospholipase A2 a Novel Predictor of Vasospasm and Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage? Neurosurgery 2019; 86:122-131. [DOI: 10.1093/neuros/nyz041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/17/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
BACKGROUND
The relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, vasospasm, and clinical outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) are still unclear.
OBJECTIVE
To identify the associations between admission Lp-PLA2 and vasospasm following subarachnoid hemorrhage and the clinical outcome of aSAH.
METHODS
A total of 103 aSAH patients who had Lp-PLA2 level obtained within 24 h postbleeding were included. The relationships between Lp-PLA2 level, vasospasm, and clinical outcome were analyzed.
RESULTS
Vasospasm was observed in 52 patients (50.49%). Patients with vasospasm had significantly higher Lp-PLA2 level than those without (P < .001). Both modified Fisher grade (P = .014) and Lp-PLA2 level (P < .001) were significant predictors associated with vasospasm. The Z test revealed that power of Lp-PLA2 was significantly higher than that of modified Fisher grade in predicting vasospasm (Z = 2.499, P = .012). At 6-mo follow-up, 44 patients (42.72%) had unfavorable outcome and 36 patients (34.95%) died. The World Federation of Neurosurgical Societies (WFNS) grade and Lp-PLA2 level were both significant predictors associated with 6-mo unfavorable outcome and mortality (all P < .001). The predictive values of Lp-PLA2 for unfavorable outcome and mortality at 6-mo tended to be lower than those of the WFNS grade, but the differences were not statistically significant (P = .366 and 0.115, respectively). Poor-grade patients having Lp-PLA2 > 200 μg/L had significantly worse 6-mo survival rate than poor-grade patients having Lp-PLA2 ≤ 200 μg/L (P = .001).
CONCLUSION
The Lp-PLA2 might be useful as a novel predictor in aSAH patients. A total of 30 poor-grade patients; those with elevated Lp-PLA2 level have higher risk of 6-mo mortality compared to those without.
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Affiliation(s)
- Chen-Yu Ding
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Han-Pei Cai
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Hong-Liang Ge
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Liang-Hong Yu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yuang-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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Mahak C, Shashi, Yashomati, Hemlata, Manisha N, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of Utilization of Rehabilitation Services among Stroke Survivors. J Neurosci Rural Pract 2018; 9:461-467. [PMID: 30271034 PMCID: PMC6126306 DOI: 10.4103/jnrp.jnrp_25_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The current study was conducted with the objective to assess the utilization of rehabilitation services and factors affecting nonutilization of rehabilitation services among the stroke survivors. MATERIALS AND METHODS The current study was carried out in the Neuro Outpatient Department of a tertiary care hospital in India. It was a descriptive study. Consecutive 55 stroke survivors who had met the inclusion and exclusion criteria were recruited in this study. Self-structured rehabilitation tool was used to collect the data. RESULTS Data were analyzed using the descriptive and inferential statistics. Majority of the patients comprised 70.9% of males and 29.1% of females. Among participants, 70.90% were aware about rehabilitation, 67% were utilizing rehabilitation services, whereas 33% were not utilizing rehabilitation services. In the current study, certain reasons were found behind not utilizing rehabilitation services. There were 83.3% of participants who had lack of awareness about rehabilitation services and 61.1% of participants who had no availability of rehabilitation services. Only 45.5% of rural inhabitants were utilizing rehabilitation services as compared to 81.2% of urban inhabitants and 83.23% of suburban inhabitants. CONCLUSION Rehabilitation is of utmost importance. Hemiparesis, difficulty in performing activity of daily living, difficulty in performing social activities, and difficulty in reasoning were the most common problems faced by people suffering stroke after discharge from the hospital. There was lack of awareness and utilization of rehabilitation services by patients among Indian stroke population. Hence, health workers have an immense role in educating, motivating, and ensuring that rehabilitation services in rural inhabitants.
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Affiliation(s)
- Chandel Mahak
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Shashi
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Yashomati
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Hemlata
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Nagi Manisha
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Ghai Sandhya
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Manju Dhandapani
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Kumar M, Goudihalli S, Mukherjee K, Dhandapani S, Sandhir R. Methylenetetrahydrofolate reductase C677T variant and hyperhomocysteinemia in subarachnoid hemorrhage patients from India. Metab Brain Dis 2018; 33:1617-1624. [PMID: 29926428 DOI: 10.1007/s11011-018-0268-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/06/2018] [Indexed: 12/19/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) polymorphism (C677T, A1298C) has been implicated in increased plasma homocysteine (Hcy) levels. The present study was designed to investigate the association between MTHFR polymorphism and increased Hcy levels in subarachnoid haemorrhage (SAH) patients. A total of 150 subjects from North India were included in the study, comprising of 100 SAH patients and 50 healthy controls. Plasma Hcy levels was determined and MTHFR polymorphism (C677T, A1298C) was screened by High resolution melting (HRM) analysis. Plasma Hcy levels were found to be significantly higher (p < 0.001) in SAH patients than in healthy controls. No significant difference in the genotype and allele frequency of MTHFR A1298C was observed. However, frequency of MTHFR C677T genotype, CT (53% vs. 20%; p < 0.001) and TT (15% vs. 2%; p < 0.05) was significantly higher in SAH group as compared to healthy controls. The frequency of T allele (41.5% vs. 12%; p < 0.001) was also found to be higher in SAH patients in comparison to healthy controls. Furthermore, Hcy levels were higher in SAH patients with TT genotype than in patients having CT genotype, whereas CC genotype had lower Hcy levels. The study suggests that higher frequency of MTHFR C677T allele may contribute to etiopathology of SAH through increase in Hcy levels.
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Affiliation(s)
- Mohit Kumar
- Department of Biochemistry, Basic Medical Sciences Block-II, Panjab University, Sector-25, Chandigarh, 160014, India
| | - Sachin Goudihalli
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kanchan Mukherjee
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rajat Sandhir
- Department of Biochemistry, Basic Medical Sciences Block-II, Panjab University, Sector-25, Chandigarh, 160014, India.
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Mohanty M, Dhandapani S, Gupta SK, Shahid AH, Patra DP, Sharma A, Mathuriya SN. Cognitive Impairments After Clipping of Ruptured Anterior Circulation Aneurysms. World Neurosurg 2018; 117:e430-e437. [PMID: 29920394 DOI: 10.1016/j.wneu.2018.06.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The cognitive impairments after treatment of ruptured aneurysms have often been underestimated. This study sought to assess their prevalence and analyze various associated factors. METHODS Patients who were operated on for ruptured anterior circulation aneurysms and discharged with a Glasgow Outcome Scale score of 4-5 were studied at 3 months for various cognitive impairments. Continuous scales of memory (recent, remote, verbal, visual, and overall memory), verbal fluency (phonemic and category fluency), and others were studied in relation to various factors. Univariate and multivariate analyses were performed using SPSS version 21. RESULTS A total of 87 patients were included in our study. Phonemic fluency was the most affected, noted in 66% of patients. Although 56% had some memory-related impairments, 13 (15%) and 6 (7%) had moderate and severe deficits in recent memory and 19 (22%) and 12 (14%) had moderate and severe deficits in remote memory, respectively. Patients operated on for anterior cerebral artery (ACA) aneurysms had significantly greater impairments in recent (34% vs. 8%) and remote memory (43% vs. 28%) compared with the rest, both in univariate (P = 0.01 and 0.002, respectively) and multivariate analyses (P = 0.01 and 0.03, respectively). ACA-related aneurysms also had significantly greater independent impairments in phonemic fluency (P = 0.04), compared with others. The clinical grade had a significant independent impact only on remote memory (P = 0.01). CONCLUSIONS Cognitive impairments are frequent after treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory, and phonemic fluency are significantly greater after treatment of ACA-related aneurysms, compared with others, independent of other factors.
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Affiliation(s)
- Manju Mohanty
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Adnan Hussain Shahid
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University HSC, Shreveport, Louisiana, USA
| | - Anchal Sharma
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh N Mathuriya
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Median Supraorbital Keyhole Approach for Clipping Ruptured Distal Anterior Cerebral Artery Aneurysm: Technical Report with Review of Literature. World Neurosurg 2018; 112:73-76. [PMID: 29410300 DOI: 10.1016/j.wneu.2018.01.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The minimally invasive approach to distal anterior cerebral artery (DACA) aneurysms has not gained much acceptance due to difficulties associated with the conventional frontal paramedian approach. The more proximal basal interhemispheric approach, however, necessitates extensive dissection of soft tissues. We describe a novel minimally invasive median supraorbital keyhole craniotomy with a basal interhemispheric approach for clipping a ruptured DACA aneurysm. METHODS A 62-year-old patient presented with subarachnoid hemorrhage. Computed tomography angiography revealed a DACA aneurysm. The surgical technique involved a keyhole craniotomy made via an eyebrow incision extending between the supraorbital notches, and flush with the anterior cranial fossa. The dura was opened at the anterior part, the falx was cut, an interhemispheric dissection was carried out, adequate proximal control was obtained, and the aneurysm neck was dissected and clipped. A relevant review of the literature was carried out. RESULTS The patient recovered well, with no residual aneurysm or forehead numbness, with good cosmesis. Compared with the previously described "keyhole unilateral interhemispheric" approaches, our technique has less likelihood of encountering bridging veins; easier cisternal cerebrospinal fluid release, making it feasible even in swollen brain; better proximal vascular control; and trajectory toward the neck rather than dome. CONCLUSION The median supraorbital keyhole approach is a minimally invasive technique sufficient for clipping most DACA aneurysms, with easier access, better proximal control, and good cosmesis.
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Bai W, Li W, Ning YL, Li P, Zhao Y, Yang N, Jiang YL, Liang ZP, Jiang DP, Wang Y, Zhang M, Zhou YG. Blood Glutamate Levels Are Closely Related to Acute Lung Injury and Prognosis after Stroke. Front Neurol 2018; 8:755. [PMID: 29403427 PMCID: PMC5785722 DOI: 10.3389/fneur.2017.00755] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Acute lung injury (ALI) is a serious complication of stroke that occurs with a high incidence. Our preclinical results indicated that ALI might be related to blood glutamate levels after brain injury. The purpose of this study was to assess dynamic changes in blood glutamate levels in patients with stroke and to determine the correlation between blood glutamate levels, ALI, and long-term prognosis after stroke. Methods Venous blood samples were collected from controls and patients with stroke at admission and on the third and seventh day after the onset of stroke. Patients were followed for 3 months. The correlations among blood glutamate levels, severities of stroke and ALI, and long-term outcomes were analyzed, and the predictive values of blood glutamate levels and severity scores for ALI were assessed. Results In this study, a total of 384 patients with stroke were enrolled, with a median age of 59 years. Patients showed significantly increased blood glutamate levels within 7 days of stroke onset (p < 0.05), and patients with more severe injuries showed higher blood glutamate levels. Moreover, blood glutamate levels were closely related to the occurrence (adjusted odds ratio, 3.022, p = 0.003) and severity (p < 0.001) of ALI and the long-term prognosis after stroke (p < 0.05), and they were a more accurate predictor of ALI than the more commonly used severity scores (p < 0.01). Conclusion These results indicated that an increased blood glutamate level was closely related to the development of ALI and a poor prognosis after stroke. Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR-RPC-15006770.
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Affiliation(s)
- Wei Bai
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei Li
- Department of Neurology, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ya-Lei Ning
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ping Li
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yan Zhao
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Nan Yang
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yu-Lin Jiang
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ze-Ping Liang
- Department of ICU, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Dong-Po Jiang
- Department of ICU, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ying Wang
- Department of Neurology, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Meng Zhang
- Department of Neurology, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yuan-Guo Zhou
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
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Kapoor A, Dhandapani S, Gaudihalli S, Dhandapani M, Singh H, Mukherjee KK. Serum albumin level in spontaneous subarachnoid haemorrhage: More than a mere nutritional marker! Br J Neurosurg 2017; 32:47-52. [PMID: 28658989 DOI: 10.1080/02688697.2017.1344615] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The role of nutritional markers on outcome following subarachnoid hemorrhage (SAH) has been scarcely described. METHODS This is a prospective study of 273 patients with SAH, in which haemoglobin, serum protein and albumin were measured within 24 hours and again at one week following ictus, and analysed with respect to other variables. New neurologic deficits (NND), infarct, mortality and Glasgow outcome scale (GOS) at 3 months were assessed. RESULTS The values of haemoglobin, total protein and albumin showed significant (p < .001) decline over the first week of SAH. Patients who developed NND had significantly lower serum albumin levels at admission compared to others (median 3.6 vs 3.9 g/dL, p < .001). Patients having lower albumin (≤3.5 gm/dL) levels at admission had significantly higher rates of NND (52% vs 20%), infarct (35% vs 23%), mortality (28% vs 16%) and unfavourable GOS (38% vs 25%). Hunt & Hess (H&H) grade and Fisher grade also affected all the outcome parameters significantly. Percentage decrease in albumin levels at one week following ictus significantly affected mortality and unfavourable GOS. On multivariate analyses, Fisher grade and lower admission albumin levels had significant impact on NND, while percentage decrease in albumin levels had significant impact on mortality and unfavourable GOS, independent of other nutritional markers and known prognostic variables. CONCLUSIONS Serum albumin levels following SAH can be useful to predict development of NND, while its further weekly decrease correlates independently with unfavourable outcome at 3 months. Albumin assessment being readily available may serve as more than a mere nutritional parameter in SAH.
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Affiliation(s)
- Ankur Kapoor
- a Department of Neurosurgery , Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Sivashanmugam Dhandapani
- a Department of Neurosurgery , Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Sachin Gaudihalli
- a Department of Neurosurgery , Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Manju Dhandapani
- b National Institute of Nursing Education (NINE), PGIMER , Chandigarh , India
| | - Harminder Singh
- c Department of Neurosurgery , Stanford University School of Medicine , Stanford , CA , USA
| | - Kanchan K Mukherjee
- a Department of Neurosurgery , Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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Liu JH, Li XK, Chen ZB, Cai Q, Wang L, Ye YH, Chen QX. D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study. Neural Regen Res 2017; 12:2014-2020. [PMID: 29323040 PMCID: PMC5784349 DOI: 10.4103/1673-5374.221158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission (within 48 hours after initial hemorrhage) and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Jun-Hui Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiang-Kui Li
- Department of Neurosurgery, Affiliated Hospital of Shandong Medical College, Linyi, Shandong Province, China
| | - Zhi-Biao Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Long Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Ying-Hu Ye
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qian-Xue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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