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Kishida K, Maruyama D, Kotani S, Murakami N, Hashimoto N. Clinical Significance of Stiffness during Endoscopic Surgery for Intracerebral Hemorrhage: A Retrospective Study. Neurol Med Chir (Tokyo) 2023; 63:563-570. [PMID: 37940569 PMCID: PMC10788487 DOI: 10.2176/jns-nmc.2023-0043] [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: 05/31/2023] [Accepted: 08/28/2023] [Indexed: 11/10/2023] Open
Abstract
Studies regarding hematoma stiffness and removal difficulty are scarce. This study explored the association between hematoma stiffness and surgical results of endoscopic hematoma removal for intracerebral hemorrhage. It also aimed to clarify factors associated with hematoma stiffness. We classified intracerebral hematoma as either soft or firm stiffness by retrospectively evaluating operative videos by two neurosurgeons. The interobserver reliability of the classification was assessed by calculating the κ values. We investigated the relationship between hematoma stiffness and surgical results. Favorable hematoma removal (FHR) was defined as a residual hematoma volume of ≤15 mL or removal rate of ≥70%. Furthermore, we compared the background characteristics, imaging findings, and laboratory data between the two groups. Forty patients were included in this study. The mean baseline hematoma volume was 69.9 mL (range, 41.3-97.6 mL). FHR was accomplished in 35 cases (87.5%). Thirty-four patients (85%) were in the soft hematoma group (group S). Six patients (15%) were in the firm hematoma group (group F). Classification of hematoma stiffness demonstrated an excellent degree of interobserver agreement (κ score = 0.91). Patients in group S had a high FHR rate (p = 0.018) and short endoscopic procedure times (p = 0.00034). The island sign was present in group S (p = 0.030). Patients in group F had significantly high fibrinogen levels (p = 0.049) and low serum total calcium (p = 0.032), hemoglobin (p = 0.041), and hematocrit (p = 0.011) levels. Hematoma stiffness during endoscopic surgery for intracerebral hemorrhage correlates with surgical results, including the endoscopic procedure time and accomplishing rate of FHR.
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Affiliation(s)
- Kengo Kishida
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Daisuke Maruyama
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Saki Kotani
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Nobukuni Murakami
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
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Lin JL, Li SL, Peng YC, Chen LW, Lin YJ. Analysis of serum calcium change trajectories and prognostic factors in patients with acute type A aortic dissection. BMC Surg 2023; 23:362. [PMID: 38012635 PMCID: PMC10683301 DOI: 10.1186/s12893-023-02249-3] [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: 05/05/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection. METHODS Patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed. RESULTS A total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P < 0.05) and in the group with continuous low serum calcium > 48 h (odds ratio = 3.595, P < 0.05). Age (odds ratio = 1.063, P < 0.001), body mass index (odds ratio = 1.138, P < 0.05), hypertension (odds ratio = 3.697, P < 0.05), and the highest lactic acid within 72 h after surgery(odds ratio = 1.093, P < 0.05) were independent risk factors for poor prognosis after aortic dissection. CONCLUSION Continuous low serum calcium was an independent predictor of poor prognosis in patients with acute type A aortic dissection.
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Affiliation(s)
- Jian-Long Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Sai-Lan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Yan-Chun Peng
- Department of Nursing, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China.
| | - Yan-Juan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China.
- Department of Nursing, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China.
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Liu M, Xiong Y, Hua X, Huang L, He W, You C, Liu M, Wu S. Prognostic value of day-of-event serum calcium and magnesium for predicting 1-year prognosis after intracerebral hemorrhage. Neurol Sci 2023; 44:3957-3965. [PMID: 37291394 DOI: 10.1007/s10072-023-06886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
AIM To investigate whether serum calcium and magnesium on the day of symptom onset contribute to prognosis at 1 year after intracerebral hemorrhage (ICH). METHODS We prospectively enrolled patients admitted < 24 h after symptom onset of primary ICH to West China Hospital between January 2012 and October 2014. Blood samples were collected at admission to determine the concentration of serum calcium and magnesium. We analyzed associations of the serum concentration of calcium and magnesium with unfavorable outcome (defined as modified Rankin scale, mRS ≥ 3) at 1 year. RESULTS We included 874 patients (mean age 59.1 ± 13.5 years, 67.6% males), of whom 470 patients had mRS ≥ 3 and 284 patients died at 1 year. Compared to patients with the highest tertile level of calcium concentration (≥ 2.29 mmol/L), patients in the lowest tertile (≤ 2.15 mmol/L) had higher odds of unfavorable outcome (odds ratio, OR 1.61, 95% confidence interval [CI] 1.04-2.50, P = 0.034). The Kaplan-Meier survival curve revealed a significant difference of cumulative survival rate across calcium tertiles (log-rank P value = 0.038). There was no significant association between serum concentration of magnesium and functional outcome at 1 year. CONCLUSION A reduced serum concentration of calcium on the day-of-event was associated with unfavorable outcome at 1 year after ICH. Future studies are needed to illustrate the pathophysiological mechanism of calcium and whether calcium could be a treatment target for improving outcomes after ICH.
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Affiliation(s)
- Meng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yao Xiong
- The Affiliated Hospital of Southwest Jiaotong University &, The Third People's Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Xing Hua
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Linrui Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Weihong He
- Department of Physiology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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4
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Li T, Zhuang D, Cai S, Ding F, Tian F, Huang M, Li L, Chen W, Li K, Sheng J. Low serum calcium is a novel predictor of unfavorable prognosis after traumatic brain injury. Heliyon 2023; 9:e18475. [PMID: 37576228 PMCID: PMC10412893 DOI: 10.1016/j.heliyon.2023.e18475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 08/15/2023] Open
Abstract
Background Accurate and convenient serological markers for prognosis after traumatic brain injury (TBI) are still lacking. We aimed to explore the predictive value of serum calcium for prognosing outcomes within 6 months after TBI. Methods In this multicenter retrospective study, 1255 and 719 patients were included in development and validation cohorts, respectively, and their 6-month prognoses were recorded. Serum calcium was measured through routine blood tests within 24 h of hospital admission. Two multivariate predictive models with or without serum calcium for prognosis were developed. Receiver operating characteristics and calibration curves were applied to estimate their performance. Results The patients with lower serum calcium levels had a higher frequency of unfavorable 6-month prognosis than those without. Lower serum calcium level at admission was associated with an unfavorable 6-month prognosis in a wide spectrum of patients with TBI. Lower serum calcium level and our prognostic model including calcium performed well in predicting the 6-month unfavorable outcome. The calcium nomogram maintained excellent performance in discrimination and calibration in the external validation cohort. Conclusions Lower serum calcium level upon admission is an independent risk factor for an unfavorable 6-month prognosis after TBI. Integrating serum calcium into a multivariate predictive model improves the performance for predicting 6-month unfavorable outcomes.
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Affiliation(s)
- Tian Li
- Shantou University Medical College, Department of Microbiology and Immunology & Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, Guangdong, China
| | - Dongzhou Zhuang
- First Affiliated Hospital of Shantou University Medical College, Department of Neurosurgery, Shantou, Guangdong, China
- Fuzong Clinical Medical College of Fujian Medical University, Department of Neurosurgery, Fuzhou, Fujian, China
| | - Shirong Cai
- First Affiliated Hospital of Shantou University Medical College, Department of Neurosurgery, Shantou, Guangdong, China
| | - Faxiu Ding
- First Affiliated Hospital of Shantou University Medical College, Department of Neurosurgery, Shantou, Guangdong, China
| | - Fei Tian
- Second Affiliated Hospital of Shantou University Medical College, Department of Neurosurgery, Shantou, Guangdong, China
| | - Mindong Huang
- Affiliated Jieyang Hospital of Sun Yat-sen University, Department of Neurosurgery, Jieyang, Guangdong, China
| | - Lianjie Li
- Fuzong Clinical Medical College of Fujian Medical University, Department of Neurosurgery, Fuzhou, Fujian, China
| | - Weiqiang Chen
- First Affiliated Hospital of Shantou University Medical College, Department of Neurosurgery, Shantou, Guangdong, China
| | - Kangsheng Li
- Shantou University Medical College, Department of Microbiology and Immunology & Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, Guangdong, China
| | - Jiangtao Sheng
- Shantou University Medical College, Department of Microbiology and Immunology & Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, Guangdong, China
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Wei J, Zhao L, Liao J, Du X, Gong H, Tan Q, Lei M, Zhao R, Wang D, Liu Q. Large Relative Surface Area of Hematomas Predict a Poor Outcome in Patients with Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2022; 31:106381. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/10/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022] Open
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Zhang P, Tu Q, Ni Z, Zheng Z, Chen Y, Yan L, Bao H, Zhuge Q, Ni H. Association between serum calcium level and hemorrhagic progression in patients with traumatic intraparenchymal hemorrhage: Investigating the mediation and interaction effects of coagulopathy. J Neurotrauma 2022; 39:508-519. [PMID: 35102758 DOI: 10.1089/neu.2021.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this study, we investigate the association of serum calcium with coagulopathy and hemorrhagic progression contusion (HPC) in patients with traumatic intraparenchymal hemorrhage (tIPH), and further explored the interaction and mediation effect between serum calcium as well as coagulopathy on HPC. Retrospective analyses of patients with tIPH admitted to the First Affiliated Hospital of Wenzhou Medical University between January 2016 to December 2019. The clinical data, coagulation parameters, and serum calcium levels were collected for further analysis. Multivariate logistic regression analysis was applied to identify the association of serum calcium level with coagulopathy and HPC. Causal mediation analysis (CMA) and additive interaction model were used to estimate the interaction and mediation effect between serum calcium as well as coagulopathy on HPC. Additionally, we repeated the analysis using corrected calcium. A total of 473 patients were included in this study. Of these, 54 (11.4%) patients had hypocalcemia at admission, 105 (22.2%) presented with coagulopathy, and 187 (39.5%) experienced HPC. Admission serum calcium level in patients presented with coagulopathy and HPC were 8.84 [IQR: 8.44-9.40] and 8.92 [IQR: 8.48-9.40] mg/dL respectively, which were significantly lower than that of patients without (9.10 [IQR: 8.68-9.88] and 9.12 [IQR: 8.72-9.89] mg/dL; all p < 0.001). Multivariate logistic regression analysis identified that hypocalcemia emerged as an independent risk factor for coagulopathy and HPC. However, no significant interaction was detected between hypocalcemia and coagulopathy. CMA showed that the mediator coagulopathy explained 24.4% (95% CI: 4.7-65.0%; p = 0.006) of the association between hypocalcemia and HPC. Moreover, comparable results were held using corrected calcium as well. Admission serum calcium level is associated with the HPC for patients with tIPH and this relationship is partially mediated by coagulopathy, but no significant interaction is detected. Further studies are needed to validate the findings and explore its mechanisms.
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Affiliation(s)
- Peng Zhang
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, China;
| | - Qi Tu
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, China;
| | - Zhihui Ni
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, China;
| | - Zezheng Zheng
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, China;
| | - Yu Chen
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, China;
| | - Lin Yan
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, Zhejiang, China.,The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China;
| | - Han Bao
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, China;
| | - Qichuan Zhuge
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Wenzhou, Zhejiang, China.,The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, Wenzhou, Zhejiang, China;
| | - Haoqi Ni
- The First Affiliated Hospital of Wenzhou Medical University, 89657, Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, wenzhou, Wenzhou, Zhejiang, China, 325000.,The First Affiliated Hospital of Wenzhou Medical University, 89657, Department of Neurosurgery, wenzhou, Wenzhou, Zhejiang, China, 325000;
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Bautista W, Adelson PD, Bicher N, Themistocleous M, Tsivgoulis G, Chang JJ. Secondary mechanisms of injury and viable pathophysiological targets in intracerebral hemorrhage. Ther Adv Neurol Disord 2021; 14:17562864211049208. [PMID: 34671423 PMCID: PMC8521409 DOI: 10.1177/17562864211049208] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/09/2021] [Indexed: 01/18/2023] Open
Abstract
Intracerebral hemorrhage (ICH) can be divided into a primary and secondary phase. In the primary phase, hematoma volume is evaluated and therapies are focused on reducing hematoma expansion. In the secondary, neuroprotective phase, complex systemic inflammatory cascades, direct cellular toxicity, and blood-brain barrier disruption can result in worsening perihematomal edema that can adversely affect functional outcome. To date, all major randomized phase 3 trials for ICH have targeted primary phase hematoma volume and incorporated clot evacuation, intensive blood pressure control, and hemostasis. Reasons for this lack of clinical efficacy in the major ICH trials may be due to the lack of therapeutics involving mitigation of secondary injury and inflexible trial design that favors unilateral mechanisms in a complex pathophysiology. Potential pathophysiological targets for attenuating secondary injury are highlighted in this review and include therapies increasing calcium, antagonizing microglial activation, maintaining macrophage M1 versus M2 balance by decreasing M1 signaling, aquaporin inhibition, NKCCl inhibition, endothelin receptor inhibition, Sur1-TRPM4 inhibition, matrix metalloproteinase inhibition, and sphingosine-1-phosphate receptor modulation. Future clinical trials in ICH focusing on secondary phase injury and, potentially implementing adaptive trial design approaches with multifocal targets, may improve insight into these mechanisms and provide potential therapies that may improve survival and functional outcome.
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Affiliation(s)
- Wendy Bautista
- Center for Advanced Preclinical Research (CAPR), National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - P David Adelson
- Division of Pediatric Neurosurgery, Department of Child Health, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Nathan Bicher
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Rm 4B42, Washington, DC 20010, USA
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Zhou Q, Zhang D, Chen X, Yang Z, Liu Z, Wei B, Jin M, Feng K, Guo C, Sun J, Chen S, Zhang R, Piao X, Gareev I, Sun Z, Wang X, Li L, Zhao S, Yang G. Plasma D-dimer predicts poor outcome and mortality after spontaneous intracerebral hemorrhage. Brain Behav 2021; 11:462-468. [PMID: 33179455 PMCID: PMC7821563 DOI: 10.1002/brb3.1946] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The elevation of plasma D-dimer levels may predict a higher risk of thrombosis and play a role in the pathological process of patients after spontaneous intracerebral hemorrhage (ICH). However, its function in predicting the prognosis of ICH has not been verified on large cases. PATIENTS AND METHODS Retrospective cohort study of 1,332 consecutive patients with spontaneous ICH at an academic medical center was conducted. Functional outcome at three months after ICH was dichotomized using the modified Rankin Scale (0-2 versus 3-6). D-dimer level in blood was analyzed within 1 hr of admission. An ICH outcome score combining D-dimer level for evaluating poor functional outcome and mortality was tested. RESULTS The proportion of patients with poor functional outcome and mortality at three months was significantly higher in patients with elevated D-dimer level (p < .001). Multivariable analysis demonstrated that elevated D-dimer level was an independent predictor of poor functional outcome (odds ratio 1.486, 95% confidence interval 1.086-2.060, p = .014) and mortality (odds ratio 2.015, 95% confidence interval 1.186-3.423, p = .01). An increasing ICH outcome score combining D-dimer level was associated with increased poor functional outcome and mortality. CONCLUSIONS Elevated plasma D-dimer level after spontaneous ICH is associated with poor functional outcome and mortality. The study suggests that elevated D-dimer level has a predictive value for outcome and mortality in patients with spontaneous ICH.
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Affiliation(s)
- Qi Zhou
- Research Administration Office, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Daming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Xin Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Zhao Yang
- Department of Neurosurgery, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Zhihui Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Mei Jin
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Kairu Feng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunmei Guo
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junying Sun
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sheng Chen
- Harbin Medical University, Harbin, China
| | | | - Xiai Piao
- Harbin Medical University, Harbin, China
| | | | - Zhenying Sun
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Xiaoxiong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Lili Li
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shiguang Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Guang Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Institute of Brain Science, Harbin Medical University, Harbin, China
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Zhou X, Chen D, Wang L, Zhao Y, Wei L, Chen Z, Yang B. Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical. Biosci Rep 2020; 40:BSR20202690. [PMID: 33252122 PMCID: PMC7755121 DOI: 10.1042/bsr20202690] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) virus is still spreading, finding out the initial hits of viral infection is important to minimize the mild/moderate population, prevent disease aggravation and organs dysfunction. Objective: We investigated COVID-19 patients with different serum calcium levels. DESIGN We checked the serum calcium level of the patients based on days after symptom onset as well as the severity of COVID-19. We also checkeed multi-organ injuries and immune cytokines level in their blood. RESULTS Both mild/moderate and severe critical cases we observed showed low calcium level in the early stage of viral infection, while the severe/critical cases showed significant lower calcium level than mild/moderate cases in the early stage. We also found that low calcium level related to severe/critical multi-organ injuries especially in the mild/moderate population. Proinflammatory cytokine IL-6 also correlated to calcium change in both mild/moderate and severe/critical cases. CONCLUSIONS Our finding indicates that calcium balance is a primal hit of COVID-19 and a biomarker of clinical severity at the beginning of symptom onset. Calcium is closely associated with virus-associated multiple organ injuryes and the increase of inflammatory cytokines. Our results provide a new, important indicator of COVID-19 patients from mild/moderate to severe/critical: serum calcium.
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Affiliation(s)
- Xi Zhou
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Dong Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Lan Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuanyuan Zhao
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Lai Wei
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Zhishui Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
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Loggini A, El Ammar F, Mansour A, Kramer CL, Goldenberg FD, Lazaridis C. Association between electrolyte levels at presentation and hematoma expansion and outcome in spontaneous intracerebral hemorrhage: A systematic review. J Crit Care 2020; 61:177-185. [PMID: 33181414 DOI: 10.1016/j.jcrc.2020.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/31/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the association between specific electrolyte levels (sodium, potassium, calcium, magnesium, and phosphorus) on presentation and hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH). METHODS This review was conducted in accordance with the PRISMA statement recommendations. Three databases were searched (Pubmed, Scopus, and Cochrane). Risk of bias was computed using the Newcastle-Ottawa Scale tool. RESULTS 18 full-text articles were included in this systematic review including 10,385 ICH patients. Hypocalcemia was associated with worse short-term outcome in four studies, and two other studies were neutral. All studies investigating HE in hypocalcemia (n = 5) reported an association between low calcium level and HE. Hyponatremia (Na < 135 mEq/L) was shown to correlate with worse short-term outcome in two studies, and worse long-term outcome in one. There was one report showing no association between sodium level and HE. Hypomagnesemia was shown to be associated with worse short-term outcome in one study, while other reports were neutral. Studies evaluating hypophosphatemia or hypokalemia in ICH were limited, with no demonstrable significant effect on outcome. CONCLUSION This review suggests a significant association between hypocalcemia, hyponatremia and, of lesser degree, hypomagnesemia on admission and HE or worse outcome in ICH.
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Affiliation(s)
- Andrea Loggini
- Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States.
| | - Faten El Ammar
- Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Ali Mansour
- Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Christopher L Kramer
- Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Fernando D Goldenberg
- Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Christos Lazaridis
- Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
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11
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Li Z, You M, Long C, Bi R, Xu H, He Q, Hu B. Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment. Front Neurol 2020; 11:702. [PMID: 32765408 PMCID: PMC7380105 DOI: 10.3389/fneur.2020.00702] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the most lethal type of stroke, but there is no specific treatment. After years of effort, neurologists have found that hematoma expansion (HE) is a vital predictor of poor prognosis in ICH patients, with a not uncommon incidence ranging widely from 13 to 38%. Herein, the progress of studies on HE after ICH in recent years is updated, and the topics of definition, prevalence, risk factors, prediction score models, mechanisms, treatment, and prospects of HE are covered in this review. The risk factors and prediction score models, including clinical, imaging, and laboratory characteristics, are elaborated in detail, but limited by sensitivity, specificity, and inconvenience to clinical practice. The management of HE is also discussed from bench work to bed practice. However, the upmost problem at present is that there is no treatment for HE proven to definitely improve clinical outcomes. Further studies are needed to identify more accurate predictors and effective treatment to reduce HE.
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Affiliation(s)
- Zhifang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingfeng You
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunnan Long
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoqiang Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Lattanzi S, Di Napoli M, Ricci S, Divani AA. Matrix Metalloproteinases in Acute Intracerebral Hemorrhage. Neurotherapeutics 2020; 17:484-496. [PMID: 31975152 PMCID: PMC7283398 DOI: 10.1007/s13311-020-00839-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) accounts for 10-30% of all strokes and affects more than one million people every year worldwide, and it is the stroke subtype associated with the highest rates of mortality and residual disability. So far, clinical trials have mainly targeted primary cerebral injury and have substantially failed to improve clinical outcomes. The understanding of the pathophysiology of early and delayed injury after ICH is, hence, of paramount importance to identify potential targets of intervention and develop effective therapeutic strategies. Matrix metalloproteinases (MMPs) represent a ubiquitous superfamily of structurally related zinc-dependent endopeptidases able to degrade any component of the extracellular matrix. They are upregulated after ICH, in which different cell types, including leukocytes, activated microglia, neurons, and endothelial cells, are involved in their synthesis and secretion. The aim of this review is to summarize the available experimental and clinical evidence about the role of MMPs in brain injury following spontaneous ICH and provide critical insights into the underlying mechanisms.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis District General Hospital, Rieti, Italy
| | - Silvia Ricci
- Department of Neurology and Stroke Unit, San Camillo de' Lellis District General Hospital, Rieti, Italy
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA.
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13
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Lower serum calcium and pre-onset blood pressure elevation in cerebral hemorrhage patients undergoing hemodialysis. Clin Exp Nephrol 2020; 24:465-473. [PMID: 31933049 DOI: 10.1007/s10157-020-01846-3] [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: 09/19/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Asymptomatic blood pressure (BP) elevation may be associated with cerebral hemorrhage (CH); however, few studies have investigated this association. We aimed to evaluate BP elevation before CH in hemodialysis (HD) patients and elucidate its associated factors. METHODS We reviewed HD patients treated for CH at our hospital between 2008 and 2019 (CH group). The control group comprised HD patients treated at Nagasaki Renal Center between 2011 and 2012. Data were obtained from medical records and three consecutive HD charts, made immediately before CH. HD1 was the session closest to onset, followed by HD2 and HD3. Systolic and mean BP were evaluated at the beginning of HD, and factors associated with BP elevation were investigated. RESULTS The CH and control groups included 105 and 339 patients, respectively. Systolic and mean BP at HD1 were significantly higher than those at baseline (HD2 + HD3) in the CH group by 5 and 3 mmHg, respectively (P < 0.001). Multiple linear regression analysis showed that lower calcium levels were significantly associated with BP elevation in the CH group (P < 0.05). The CH group was sub-divided by June 2013; the latter group had lower calcium levels (9.2 mg/dL) and a marked systolic BP difference from baseline (+ 10 mmHg) compared with the former (9.5 mg/dL and - 4 mmHg). CONCLUSION Asymptomatic BP elevation was observed in HD patients before CH; this elevation was associated with lower serum calcium levels and observed more frequently in the recent era. The precise mechanism underlying this effect remains unknown.
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14
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Jafari M, Di Napoli M, Lattanzi S, Mayer SA, Bachour S, Bershad EM, Damani R, Datta YH, Divani AA. Serum magnesium level and hematoma expansion in patients with intracerebral hemorrhage. J Neurol Sci 2019; 398:39-44. [PMID: 30682519 DOI: 10.1016/j.jns.2019.01.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/25/2018] [Accepted: 01/15/2019] [Indexed: 12/28/2022]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is a devastating subtype of stroke that results in significant rates of mortality and morbidities. The initial hematoma volume, hematoma expansion (HE), blood pressure (BP), and coagulopathy are considered strong predictors of clinical outcomes and mortality. Low serum magnesium (Mg++) levels have been shown to be associated with larger initial hematoma and greater HE. Coagulopathy, platelet dysfunction, high BP, and increased inflammatory response might form the mechanistic link between low serum Mg++ levels, larger hematoma size and greater HE. However, randomized clinical trials administering intravenous Mg++ have shown no benefit over placebo in ICH patients. The confounding effect of hypocalcemia and a delay in Mg++ trafficking across the blood-brain barrier might explain the futile results for intravenous Mg++ therapy. In the current review, we will discuss the evidence regarding the possible role of low serum Mg++ level on HE in acute ICH.
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Affiliation(s)
- Mostafa Jafari
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Mario Di Napoli
- Department of Neurology, San Camillo de' Lellis District General Hospital, Rieti, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
| | - Salam Bachour
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Eric M Bershad
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Rahul Damani
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Yvonne H Datta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Afshin A Divani
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States.
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