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Wang G, Wu BF, Zhao WJ, Hu WP, Wang JY, Gao HZ. C-reactive protein is a predictor for lower-extremity deep venous thrombosis in patients with primary intracerebral hemorrhage. Eur J Med Res 2024; 29:311. [PMID: 38845036 PMCID: PMC11157878 DOI: 10.1186/s40001-024-01842-3] [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: 02/16/2024] [Accepted: 04/13/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Our study aimed to determine whether there exists an association between low-grade systemic inflammation, as measured by serum C-reactive protein (CRP), and the risk of lower-extremity deep venous thrombosis (LEDVT) in patients with primary intracerebral hemorrhage (ICH). METHODS This observational study was retrospectively conducted on patients with primary ICH who were presented to two tertiary medical centers between January 2021 and August 2022. The primary outcome was detecting LEDVT occurrence within 14 days from the onset of the acute ICH episode. Weighted logistic regression and restricted cubic spline models were employed to estimate the association between CRP and LEDVT following 1:1 propensity score matching (PSM). RESULTS Of the 538 patients with primary ICH who met the inclusion criteria, 76 (14.13%) experienced LEDVT. Based on the cut-off levels of CRP measured upon admission from the receiver operating characteristic (ROC) curve, patients with primary ICH were categorized into two groups: (i) CRP < 1.59 mg/L and (ii) CRP ≥ 1.59 mg/L. After 1:1 PSM, the LEDVT events occurred in 24.6% of patients with CRP ≥ 1.59 mg/L and 4.1% of patients with CRP < 1.59 mg/L (P < 0.001). ROC curve revealed the area under the ROC curve of 0.717 [95% confidence interval (CI) 0.669-0.761, P < 0.001] for CRP to predict LEDVT with a sensitivity of 85.71% and specificity of 56.29%. After adjusting for all confounding variables, the occurrence of LEDVT in ICH patients with higher CRP levels (≥ 1.59 mg/L) was 10.8 times higher compared to those with lower CRP levels (95% CI 4.5-25.8, P < 0.001). A nonlinear association was observed between CRP and an increased risk of LEDVT in the fully adjusted model (P for overall < 0.001, P for nonlinear = 0.001). The subgroup results indicated a consistent positive link between CRP and LEDVT events following primary ICH. CONCLUSIONS Higher initial CRP levels (CRP as a dichotomized variable) in patients with primary ICH are significantly associated with an increased risk of LEDVT and may help identify high-risk patients with LEDVT. Clinicians should be vigilant to enable early and effective intervention in patients at high risk of LEDVT.
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Affiliation(s)
- Gang Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Lab of Neurology of Gansu Province, Lanzhou, China
| | - Bao-Fang Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Wen-Jun Zhao
- Department of Health Management Center, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Wei-Peng Hu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Jia-Yin Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China.
| | - Hong-Zhi Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China.
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Murthy SB. Emergent Management of Intracerebral Hemorrhage. Continuum (Minneap Minn) 2024; 30:641-661. [PMID: 38830066 DOI: 10.1212/con.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Nontraumatic intracerebral hemorrhage (ICH) is a potentially devastating cerebrovascular disorder. Several randomized trials have assessed interventions to improve ICH outcomes. This article summarizes some of the recent developments in the emergent medical and surgical management of acute ICH. LATEST DEVELOPMENTS Recent data have underscored the protracted course of recovery after ICH, particularly in patients with severe disability, cautioning against early nihilism and withholding of life-sustaining treatments. The treatment of ICH has undergone rapid evolution with the implementation of intensive blood pressure control, novel reversal strategies for coagulopathy, innovations in systems of care such as mobile stroke units for hyperacute ICH care, and the emergence of newer minimally invasive surgical approaches such as the endoport and endoscope-assisted evacuation techniques. ESSENTIAL POINTS This review discusses the current state of evidence in ICH and its implications for practice, using case illustrations to highlight some of the nuances involved in the management of acute ICH.
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Fang X, Shen Y, Wang M, Dai L, Shi L, Zhang F, Chen C, Yuan Y. Predictive value of Caprini risk assessment model, D-dimer, and fibrinogen levels on lower extremity deep vein thrombosis in patients with spontaneous intracerebral hemorrhage. Front Neurol 2024; 15:1370029. [PMID: 38872827 PMCID: PMC11169938 DOI: 10.3389/fneur.2024.1370029] [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: 01/13/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Research indicates that individuals experiencing hemorrhagic stroke face a greater likelihood of developing lower extremity deep vein thrombosis (DVT) compared to those with ischemic stroke. This study aimed to assess the predictive capacity of the Caprini risk assessment model (RAM), D-dimer (D-D) levels, and fibrinogen (FIB) levels for lower extremity DVT in patients with spontaneous intracerebral hemorrhage (sICH). Methodology This study involved a retrospective analysis of medical records from all sICH patients admitted to Shanghai General Hospital between June 2020 and June 2023. Within 48 h of admission, patients underwent routine screening via color Doppler ultrasonography (CDUS). Patients were categorized into the DVT and control groups based on the occurrence of lower extremity DVT during hospitalization. Differences in Caprini RAM, D-dimer, and FIB levels between the two groups were compared. The sensitivity and specificity of combined Caprini RAM, peripheral blood D-dimer, and FIB levels in predicting lower extremity DVT in sICH patients were analyzed. Receiver operating characteristic (ROC) curves assessed the overall predictive accuracy of Caprini RAM, D-D, and FIB levels. Results The study involving 842 sICH patients revealed 225 patients with DVT and 617 patients without DVT. Caprini RAM, D-D, and FIB levels were significantly higher in the DVT group compared to the control group (P < 0.05). Sensitivity values for Caprini RAM, D-D, and FIB levels in predicting lower extremity DVT in sICH patients were 0.920, 0.893, and 0.680, respectively, while specificities were 0.840, 0.680, and 0.747, respectively. The ROC curve analysis demonstrated an area under the curve (AUC) of 0.947 for combined DVT prediction, with 97.33% sensitivity and 92.00% specificity, indicating superior predictive value compared to individual applications of Caprini RAM, D-D, and FIB levels. Conclusion The combined utilization of Caprini RAM, D-D, and FIB levels holds significant clinical relevance in predicting lower extremity DVT in sICH patients.
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Affiliation(s)
- Xia Fang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Shen
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Wang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihong Dai
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linlin Shi
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Zhang
- Department of Nursing, Xinqiao Town Community Health Service Center, Songjiang District, Shanghai, China
| | - Congcong Chen
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Yuan
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Xu D, Xiong H, Cui S, Tan J, Ma Y, He Z. Construction and validation of a perioperative concomitant lower extremity deep vein thrombosis line graph model in patients with aneurysmal subarachnoid hemorrhage. Heliyon 2024; 10:e27415. [PMID: 38486761 PMCID: PMC10938113 DOI: 10.1016/j.heliyon.2024.e27415] [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: 07/11/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Background To develop and validate a nomogram for predicting the probability of deep venous thrombosis (DVT) in patients with aneurysmal subarachnoid hemorrhage (aSAH) during the perioperative period, using clinical features and readily available biochemical parameters. Methods The least absolute shrinkage and selection operator (LASSO) regression technique was employed for data dimensionality reduction and selection of predictive factors. A multivariable logistic regression analysis was conducted to establish a predictive model and nomogram for post-aSAH DVT. The discriminative ability of the model was determined by calculating the area under the curve (AUC). Results A total of 358 aSAH patients were included in the study, with an overall incidence of DVT of 20.9%. LASSO regression identified four variables, including age, modified Fisher grade, total length of hospital stay, and anticoagulation therapy, as highly predictive factors for post-aSAH DVT. The patients were randomly divided into a modeling group and a validation group in a 6:4 ratio to construct the nomogram. The AUCs of the modeling and validation groups were 0.8511 (95% CI, 0.7922-0.9099) and 0.8633 (95% CI, 0.7968-0.9298), respectively. Conclusions The developed nomogram exhibits good accuracy, discriminative ability, and clinical utility in predicting DVT, aiding clinicians in identifying high-risk individuals and implementing appropriate preventive and treatment measures.
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Affiliation(s)
- Daiqi Xu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Xiong
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shizhen Cui
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiahe Tan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yinrui Ma
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaohui He
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Dong C, Li Y, Ma Z. Venous thromboembolism after spontaneous intracerebral hemorrhage and the status quo of anticoagulation in this population: A retrospective casecontrol study from a tertiary hospital in China. Clin Neurol Neurosurg 2023; 231:107839. [PMID: 37348314 DOI: 10.1016/j.clineuro.2023.107839] [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: 02/12/2023] [Revised: 05/28/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Patients with spontaneous intracerebral hemorrhage (sICH) are susceptible to venous thromboembolism (VTE) including pulmonary embolism (PE) and deep venous thrombosis (DVT) due to a variety of risk factors. There are few studies regarding the predictive value of D-dimer for VTE in patients with sICH, and the anticoagulation therapy for these patients are still controversial. The objective of this study is to study the independent predictors of VTE in sICH patients. The rates of anticoagulation therapy and hemorrhagic evens were also investigated. METHODS Retrospective review of patients with sICH admitted to the First Affiliated Hospital of Dalian Medical University from 2012 to 2022 and who developed VTE (PE and/or DVT) during hospitalization. A similar number of sICH patients without VTE were randomly selected into the control group. A variety of clinical characteristics were compared between groups. Univariate and multivariate analyses were performed to identify independent predictors of VTE in patients with sICH. RESULTS A total of 270 sICH patients were enrolled in this study, including 132 patients with VTE and 138 patients without VTE. After adjusting for other confounders, the maximum level of D-dimer during hospitalization (odds ratio [OR] 1.061, 95 % confidence interval (CI) 1.014-1.110), Glasgow coma scale (GCS) on admission (OR 1.347, 95 % CI 1.110-1.634), modified Rankin Scale (mRS) at discharge (OR 2.578, 95 % CI 1.546-4.298), neutrophil count (OR 1.056, 95 % CI 1.025-1.088) and hospitalization time (OR 1.089, 95 % CI 1.018-1.164) were independently associated with the sICH patients who developed VTE. The maximum D-dimer plasma level of 5.655 mg/L during hospitalization was the optimal threshold to indicate sICH patients developing VTE with a sensitivity of 83.3 % and a specificity of 67.4 %. No patients with sICH received prophylactic anticoagulation therapy against VTE in the present study. A total of 57.6 % (76/132) of the sICH patients with VTE were administered anticoagulant therapy and the rate of hemorrhagic complication was 9.2 %. CONCLUSIONS sICH patients with increased levels of D-dimer, higher GCS scores, higher mRS scores, increased neutrophil counts and longer hospitalization time are more likely to develop VTE complications. Routine and serial monitoring of the D-dimer values may be useful in patients with sICH, and VTE should be considered when the plasma level of D-dimer increases to 5.655 mg/L during hospitalization. In tertiary hospitals in China, the rate of sICH patients with VTE receiving anticoagulation treatment is low. Further studies are necessary to explore the safety and efficacy of VTE therapeutic anticoagulation in patients with sICH.
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Affiliation(s)
- Chang Dong
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Li
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Zhuang Ma
- School of Clinical Medicine, Dalian Medical University, Dalian, China; Department of Respiratory and Critical Care Medicine, General Hospital of Northern Theater Command, Shenyang, China.
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Qin Y, Zhang B, Zhao S, Wang W, Dong S, Miao Y, Zhao S, Liu L, Wu Z, Kang J, Liu A. Association between higher systemic immune inflammation index (SII) and deep vein thrombosis (DVT) in patients with aneurysmal subarachnoid hemorrhage (aSAH) after endovascular treatment. Neurosurg Rev 2023; 46:142. [PMID: 37338601 DOI: 10.1007/s10143-023-02048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/21/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
Inflammation contributes to deep vein thrombosis (DVT) formation in patients with aSAH after endovascular treatment. The relationship between systemic immune-inflammatory index (SII) as an inflammatory marker and DVT formation remains unclear. Thus, this study aims to evaluate the association between SII and aSAH-associated DVT following endovascular treatment. We enrolled 562 consecutive patients with aSAH after endovascular treatment at three centers from January 2019 to September 2021. The endovascular treatments included simple coil embolization and stent-assisted coil embolization. Deep venous thrombosis (DVT) was assessed by Color Doppler ultrasonography (CDUS). Multivariate logistic regression analysis was used to establish the model. We assessed the association of the SII, neutrophil-to-lymphocyte ratio (NLR), the systemic inflammatory response index (SIRI), platelet-lymphocyte ratio (PLR), and DVT by using restricted cubic spline (RCS). ASAH-associated DVT was found in 136 (24.20%) patients. Based on the multiple logistic regression analysis, the correlation was found between aSAH-associated DVT and elevated SII (fourth quartile) (adjusted odds ratio = 8.20 [95% confidence interval, 3.76-17.92]; p < 0.001 [p for trend < 0.001]), elevated NLR (fourth quartile) (adjusted odds ratio = 6.94 [95% confidence interval, 3.24-14.89]; p < 0.001 [p for trend < 0.001]), elevated SIRI (fourth quartile) (adjusted odds ratio = 4.82 [95% confidence interval, 2.36-9.84]; p < 0.001 [p for trend < 0.001]), and elevated PLR (fourth quartile) (adjusted odds ratio = 5.49 [95% confidence interval, 2.61-11.57]; p < 0.001 [p for trend < 0.001]). The increased SII was correlated with the formation of aSAH-associated DVT after endovascular treatment.
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Affiliation(s)
- Yongkai Qin
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Baorui Zhang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shangfeng Zhao
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Wang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Siyuan Dong
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yan Miao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Songfeng Zhao
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Chen L, Zhang W, Liu C. Combination of D-dimer and Albumin in the Prediction of Deep Vein Thrombosis in Patients with Spontaneous Intracerebral Hemorrhage. Clin Appl Thromb Hemost 2023; 29:10760296231165054. [PMID: 36946100 PMCID: PMC10034306 DOI: 10.1177/10760296231165054] [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: 03/23/2023] Open
Abstract
BACKGROUND AND PURPOSE Deep venous thrombosis (DVT) makes spontaneous intracerebral hemorrhage (ICH) treatment more challenging. We aimed to determine the predictive ability of D-dimer combination with albumin for DVT in spontaneous ICH. METHODS Spontaneous ICH patients were retrospectively included. Univariate and multivariate logistic regression analyses were performed. The restricted cubic spline (RCS) curve was adopted. Multivariate logistic regression analysis was further conducted to assess the predictive powers of D-dimer and albumin in different models. Besides, the incremental predictive ability of D-dimer combination with albumin was evaluated with areas under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination index (IDI). RESULTS D-dimer was significantly higher, while albumin was considerably lower in the DVT group than in the non-DVT group [D-dimer, 0.47 (0.29, 1.08) versus 0.98 (0.48, 2.49), P < .001; albumin, 39.45 ± 7.05 versus 36.93 ± 4.77, P < .001). The multivariate logistic regression analysis showed that higher D-dimer and lower albumin were independently related to DVT after controlling confounders (D-dimer, OR = 1.061, 95% CI = 1.012-1.112, P = .013; albumin, OR = 0.934, 95% CI = 0.895-0.973, P = .001). The best cut-off value of the D-dimer was 0.40, and the albumin was 37.15. Besides, D-dimer and albumin had good predictive abilities in different models. The AUC, NRI, and IDI revealed that models that included the D-dimer combination with albumin had better predictability than those without. CONCLUSIONS D-dimer combination with albumin has a good predictability of DVT in spontaneous ICH.
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Affiliation(s)
- Lingli Chen
- Department of Neurology, 625444The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wanli Zhang
- Department of Neurology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunfeng Liu
- Department of Neurology, 625444The Second Affiliated Hospital of Soochow University, Suzhou, China
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Li L, Murthy SB. Cardiovascular Events After Intracerebral Hemorrhage. Stroke 2022; 53:2131-2141. [DOI: 10.1161/strokeaha.122.036884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular events after primary intracerebral hemorrhage (ICH) have emerged as a leading cause of poor functional outcomes and mortality during the long-term recovery after an ICH. These events encompass arterial ischemic events such as ischemic stroke and myocardial infarction, arterial hemorrhagic events that include recurrent ICH, and venous thrombotic events such as venous thromboembolism. The purpose of this review is to summarize the cardiovascular complications after ICH, epidemiology and associated risk factors, and their impact on ICH outcomes. Additionally, we will highlight possible pathophysiological mechanisms to explain the short- and long-term increased risks of ischemic and hemorrhagic events after ICH. Finally, we will highlight potential secondary stroke and venous thrombotic prevention strategies often not considered after ICH, balanced against the risk of ICH recurrence.
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Affiliation(s)
- Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L.)
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (S.B.M.)
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Mureșan EM, Golea A, Vesa Ș, Lenghel M, Csutak C, Perju‑Dumbravă L. Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study. Exp Ther Med 2022; 23:200. [PMID: 35126703 PMCID: PMC8794556 DOI: 10.3892/etm.2022.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (sICH) results in high morbidity and mortality rates, thus identifying strategies for timely prognosis and treatment is important. The present study aimed to analyze the relationship between emergency department point-of-care (POC) blood biomarkers and day 90 functional outcome (FO) in patients with acute (<8 h) sICH. On-site POC determinations, including complete blood count, glucose, cardiac troponin I, D-dimer and C-reactive protein, and derived inflammatory indexes were performed for a cohort of 35 patients. The primary endpoint was a favorable day 90 FO (modified Rankin Score ≤3). Secondary endpoints included early neurological worsening (ENW), day 7/discharge neurological impairment, day 90 independence assessment (Barthel Index <60), hematoma enlargement and perihematomal edema (PHE) growth. A favorable three-month FO was reported in 16 (46%) participants. Older age, previous history of ischemic stroke and initial imagistic parameters, including intraventricular hemorrhage, enlarged contralateral ventricle and cerebral atrophy, significantly predicted an unfavorable FO. The admission D-dimer similarly predicted day 90 FO and the independence status, along with ENW and a more severe day 7/discharge neurological status. The D-dimer also correlated with the initial neurological status and PHE. PHE growth correlated with granulocytes, systemic immune-inflammation index and glycemia. The results suggested that a lower admission D-dimer could indicate an improved day 90 FO of patients with sICH, while also anticipating the development of PHE growth and ENW.
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Affiliation(s)
- Eugenia-Maria Mureșan
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Discipline, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400006 Cluj‑Napoca, Romania
| | - Ștefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400349 Cluj‑Napoca, Romania
| | - Manuela Lenghel
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Csaba Csutak
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Lăcrămioara Perju‑Dumbravă
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
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Zhuang L, Yu C, Xu F, Zhao LH, Wang XH, Wang CH, Ning LY, Zhang XL, Zhang DM, Wang XQ, Su JB. Increased plasma D-dimer levels may be a promising indicator for diabetic peripheral neuropathy in type 2 diabetes. Front Endocrinol (Lausanne) 2022; 13:930271. [PMID: 36082076 PMCID: PMC9445160 DOI: 10.3389/fendo.2022.930271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased plasma D-dimer levels have been reported to be associated with a range of adverse health outcomes. This study aimed to determine whether plasma D-dimer is connected to diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes (T2D). METHODS This study was part of a series exploring the potential risks for DPN. All patients were questioned for neurologic symptoms, examined for neurologic signs, and received nerve conduction studies to collect nerve action potential onset latency, amplitude, and nerve conduction velocity (NCV). Composite Z scores of latency, amplitude, and NCV were calculated. DPN was confirmed as both at least a neurologic symptom/sign and an abnormality of nerve conduction studies. Coagulation function indices, such as plasma D-dimer levels, were also synchronously detected. RESULTS We finally recruited 393 eligible patients for this study, of whom 24.7% (n = 97) were determined to have DPN. The plasma D-dimer level was found to be closely associated with the composite Z score of latency, amplitude, and NCV after adjusting for other coagulation function indices and clinical covariates (latency: β = 0.134, t = 2.299, p = 0.022; amplitude: β = -0.138, t = -2.286, p = 0.023; NCV: β = -0.139, t = -2.433, p = 0.016). Moreover, the prevalence of DPN in the first, second, third, and fourth quartiles (Q1, Q2, Q3, and Q4) of the D-dimer level was 15.2%, 15.9%, 26.4%, and 42.7%, respectively (p for trend < 0.001). The corresponding adjusted odds ratios and 95% CIs for DPN in D-dimer quartiles were 1, 0.79 (0.21-2.99), 1.75 (0.49-6.26), and 5.17 (1.38-19.42), respectively. Furthermore, the optimal cutoff value of the plasma D-dimer level to discriminate DPN was ≥0.22 mg/L (sensitivity = 67.01%, specificity = 58.78%, and Youden index = 0.26) after analysis by the receiver operating characteristic curve. CONCLUSIONS Increased plasma D-dimer levels may be a promising indicator for DPN in patients with T2D.
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Affiliation(s)
- Lei Zhuang
- Department of Endocrinology, Second People's Hospital of Nantong City, Nantong, China
| | - Chao Yu
- Department of Clinical Laboratory, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Feng Xu
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Li-Hua Zhao
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Xiao-Hua Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Chun-Hua Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Li-Yan Ning
- Department of Administration, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Xiu-Lin Zhang
- Department of Clinical Laboratory, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Dong-Mei Zhang
- Medical Research Center, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Xue-Qin Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
| | - Jian-Bin Su
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People's Hospital of Nantong City, Nantong, China
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11
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Tao J, Lou F, Liu Y. The Role of Vitamin D in the Relationship Between Gender and Deep Vein Thrombosis Among Stroke Patients. Front Nutr 2021; 8:755883. [PMID: 34926545 PMCID: PMC8674815 DOI: 10.3389/fnut.2021.755883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Accumulating evidence had demonstrated that females had a higher risk of deep vein thrombosis (DVT) than males, but the mechanism was still unknown. Vitamin D was found to play an essential role in DVT, and gender may influence the serum vitamin D levels. This study aimed to explore whether vitamin D played a role in the gender difference in DVT. Materials and Methods: A total of 444 patients with acute stroke were recruited, which were divided into the DVT group (n = 222) and the non-DVT group (n = 222). Serum vitamin D levels were measured after admission and were split into three categories, including deficiency (<50 nmol/L), insufficiency (52.5–72.5 nmol/L), and sufficiency (more than 75 nmol/L). Hierarchical regression analysis was adopted to analyze the relationship between gender and DVT, controlling the confounding factors. Results: Females showed a higher proportion of DVT than males (60.7 vs. 42.5%, p < 0.001), and lower serum vitamin D levels than males (53.44 ± 16.45 vs. 69.43 ± 23.14, p < 0.001). Moreover, serum vitamin D levels were lower in the DVT group than in the non-DVT group (59.44 ± 19.61 vs. 66.24 ± 23.86, p < 0.001). Besides, the DVT group showed a lower proportion of vitamin D sufficiency than the non-DVT group (21.2 vs. 32.9%, p < 0.05). Hierarchical regression analysis showed that females had 2.083-fold (p < 0.001, unadjusted model) and 1.413-fold (p = 0.155, adjusted model) risk to develop DVT. In addition, the sufficiency status of vitamin D showed an independent protective effect on DVT (unadjusted model OR, 0.504, p = 0.004; adjusted model OR, 0.686, p = 0.011). Conclusion: Females had a higher risk of DVT than males, and vitamin D may play an essential role in this relationship. Further studies are needed to explore whether vitamin D supplementation could reduce DVT risk in stroke patients, especially females.
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Affiliation(s)
- Jiejie Tao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feiling Lou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Cai Q, Zhang X, Chen H. Patients with venous thromboembolism after spontaneous intracerebral hemorrhage: a review. Thromb J 2021; 19:93. [PMID: 34838069 PMCID: PMC8626951 DOI: 10.1186/s12959-021-00345-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/14/2021] [Indexed: 01/17/2023] Open
Abstract
Background Patients with spontaneous intracerebral hemorrhage (ICH) have a higher risk of venous thromboembolism (VTE) and in-hospital VTE is independently associated with poor outcomes for this patient population. Methods A comprehensive literature search about patients with VTE after spontaneous ICH was conducted using databases MEDLINE and PubMed. We searched for the following terms and other related terms (in US and UK spelling) to identify relevant studies: intracerebral hemorrhage, ICH, intraparenchymal hemorrhage, IPH, venous thromboembolism, VTE, deep vein thrombosis, DVT, pulmonary embolism, and PE. The search was restricted to human subjects and limited to articles published in English. Abstracts were screened and data from potentially relevant articles was analyzed. Results The prophylaxis and treatment of VTE are of vital importance for patients with spontaneous ICH. Prophylaxis measures can be mainly categorized into mechanical prophylaxis and chemoprophylaxis. Treatment strategies include anticoagulation, vena cava filter, systemic thrombolytic therapy, catheter-based thrombus removal, and surgical embolectomy. We briefly summarized the state of knowledge regarding the prophylaxis measures and treatment strategies of VTE after spontaneous ICH in this review, especially on chemoprophylaxis and anticoagulation therapy. Early mechanical prophylaxis, especially with intermittent pneumatic compression, is recommended by recent guidelines for patients with spontaneous ICH. While decision-making on chemoprophylaxis and anticoagulation therapy evokes debate among clinicians, because of the concern that anticoagulants may increase the risk of recurrent ICH and hematoma expansion. Uncertainty still exists regarding optimal anticoagulants, the timing of initiation, and dosage. Conclusion Based on current evidence, we deem that initiating chemoprophylaxis with UFH/LMWH within 24–48 h of ICH onset could be safe; anticoagulation therapy should depend on individual clinical condition; the role of NOACs in this patient population could be promising.
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Affiliation(s)
- Qiyan Cai
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xin Zhang
- Respiratory Disease Department, Xinqiao Hospital, Chongqing, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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13
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A Nomogram for Predicting Venous Thromboembolism in Critically Ill Patients with Primary Intracerebral Hemorrhage. World Neurosurg 2021; 157:e301-e307. [PMID: 34648989 DOI: 10.1016/j.wneu.2021.10.071] [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: 08/02/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop and validate a nomogram for predicting the risk of venous thromboembolism in critically ill patients with primary intracerebral hemorrhage. METHODS Patients ≥18 years old with primary intracerebral hemorrhage were screened within 24 hours of onset from January 2019 to April 2021. Univariate and multivariate logistic regression analyses were performed to screen out independent predictors that were significantly associated with venous thromboembolism. A nomogram was constructed based on the results of a multivariate regression analysis. Discrimination and calibration were used to evaluate performance of the nomogram. A decision curve analysis was used to assess its clinical utility. RESULTS This study enrolled 369 patients. The nomogram included 3 predictors from the regression analysis: D-dimer, National Institutes of Health Stroke Scale score, and Glasgow Coma Scale score on admission. The area under the receiver operating characteristic curve was 0.794, indicating good discrimination of the nomogram. The nomogram demonstrated calibration curves with slight deviation from the ideal predictions. Decision curve analysis showed that the prediction nomogram was clinically useful. CONCLUSIONS This nomogram comprising D-dimer, National Institutes of Health Stroke Scale score and Glasgow Coma Scale score on admission can accurately predict the risk of venous thromboembolism in critically ill patients with intracerebral hemorrhage.
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14
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Khripun AI, Pryamikov AD, Mironkov AB, Asratyan SA, Suryakhin VS, Petrenko NV, Luk'yanova EA. [Venous thromboembolic complications in patients with intracerebral hemorrhage]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:41-46. [PMID: 34553580 DOI: 10.17116/jnevro202112108241] [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: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of various heparin therapy regimens for venous thromboembolic complications in patients with acute cerebral circulatory disorders of the hemorrhagic type. MATERIAL AND METHODS In a prospective single-center study, treatment results of 62 patients with hypertensive brain hematoma were analyzed. All patients were divided into two comparable groups: the group of «very early» prophylactic heparin therapy or the first 48 hours from the moment of the disease (n=35) and the group of «early» prophylactic heparin therapy, or later than 48 hours from the moment of the intracerebral hematoma development (n=27). The end points of the study were: venous thrombosis, pulmonary embolism (fatal and non-fatal), recurrent intracerebral hemorrhage, other clinically significant hemorrhagic complications, and intrahospital mortality. RESULTS In the group of «very early» and «early» prophylactic heparin therapy, the results were as follows: venous thrombosis 22.9% vs. 29.6% (p=0.36), total rate of PE 2.9% vs. 11.1% (p=0.03), nonfatal PE 0% vs. 7.4% (p=0.007), fatal PE 2.9% vs. 3.7% (p=0.76), recurrent intracerebral hemorrhage and other hemorrhagic complications 0% in both groups, intrahospital mortality was 54.3% versus 48.1% (p=0.54). CONCLUSION The earliest administration of direct anticoagulants in prophylactic doses in patients with hemorrhagic stroke leads to the decrease in the frequency of venous thrombosis and thromboembolic complications, without being accompanied by the development of repeated intracranial and other hemorrhagic events.
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Affiliation(s)
- A I Khripun
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A D Pryamikov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Buyanov City Clinical Hospital, Moscow, Russia
| | - A B Mironkov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Buyanov City Clinical Hospital, Moscow, Russia
| | | | | | | | - E A Luk'yanova
- Pirogov Russian National Research Medical University, Moscow, Russia
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15
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Chu Q, Liao L, Wei W, Ye Z, Zeng L, Qin C, Tang Y. Venous Thromboembolism in ICU Patients with Intracerebral Hemorrhage: Risk Factors and the Prognosis After Anticoagulation Therapy. Int J Gen Med 2021; 14:5397-5404. [PMID: 34526808 PMCID: PMC8436256 DOI: 10.2147/ijgm.s327676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose Venous thromboembolism (VTE) is a common complication of intracerebral hemorrhage (ICH) patients in intensive care unit (ICU), but anticoagulation therapy of ICH patients with VTE remains controversial. We aim to explore the risk factors and prognosis of anticoagulation therapy in ICH patients with VTE. Patients and Methods Medical records of ICH patients were collected from the Medical Information Mart for Intensive Care III (MIMIC-III version 1.4) database. The risk factors and prognosis of anticoagulation therapy in ICH patients with VTE were assessed by multivariable logistic regression analysis and Kaplan–Meier survival analysis, respectively. Results A total of 848 ICH patients were included in our study, of whom 69 ICH patients with VTE were screened, including 58 patients with deep vein thrombosis (DVT), 12 patients with pulmonary embolism (PE), and 1 patient with DVT and PE. In the multivariable logistic regression analysis, malignancy (odds ratio (OR): 4.262, 95% confidence interval (CI): 2.263–8.027, P=0.000), pulmonary circulation disease (OR: 28.717, 95% CI: 9.566–86.208, P=0.000), coagulopathy (OR: 2.453, 95% CI: 1.098–5.483, P=0.029), age > 60 years old (OR: 2.138, 95% CI: 1.087–4.207, P=0.028) and hospitalization time > 16 days (OR: 2.548, 95% CI: 1.381–4.701, P=0.003) were independent risk factors for VTE in ICH patients. Kaplan–Meier survival analysis and log-rank test found that, compared to non-anticoagulation group, anticoagulation group had higher cumulative survival rates during hospitalization, 28-day, 3-month, 1-year, and 4-year after admission, respectively. Conclusion Malignancy, pulmonary circulation disease, coagulopathy, age >60 years old and hospitalization time >16 days were independent risk factors for VTE in ICH patients, and anticoagulation therapy for VTE in ICH patients may be safe and effective. These findings need to be verified by more high-quality and well-designed randomized controlled trials.
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Affiliation(s)
- Quanhong Chu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Lin Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Wenxin Wei
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Li Zeng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yanyan Tang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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16
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Yang J, Wang K, Liu Q, Mo S, Wu J, Yang S, Guo R, Yang Y, Zhang J, Liu Y, Cao Y, Wang S. A nomogram to predict the risk of early postoperative ischemic events in patients with spontaneous intracranial hematoma. Neurosurg Rev 2021; 44:3557-3566. [PMID: 33877464 DOI: 10.1007/s10143-021-01533-1] [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: 12/09/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/27/2022]
Abstract
Spontaneous intracranial hematoma (ICH) is the second leading cause of stroke and has a high risk of postoperative ischemic events (PIEs). But, the evidence on PIEs in ICH patients still lacks. Therefore, a retrospective study was carried out to screen the risk factors for PIEs and construct a visual predictive model. This was a retrospective study whose population were divided into two groups based on the occurrence of PIEs. Univariate logistic regression analysis was used to determine factors associated with PIEs. Multifactorial logistic regression analysis was used to screen risk factors and construct the early PIEs risk nomogram. In addition, impact of PIEs on patient prognosis and surgery related costs was assessed. Out of 122 ICH patients, 24 (19.7%) were diagnosed with PIEs. Coronary heart disease history, ischemic stroke history, regular shaped hematoma and platelet number were identified as risk factors for early PIEs. Early PIEs risk nomogram showed good calibration and discrimination of the data with concordance index of 0.846 (95% confidence interval, 0.747-0.945) which was confirmed to be 0.827 through bootstrapping validation. In addition, there was statistical difference in discharged Glasgow Coma Scale score (P = 0.046) and surgery related costs (p = 0.031) between PIEs group and nPIEs group. These results showed the early PIEs risk nomogram was accurate for prediction risks of PIEs and the occurrence of PIEs affects prognosis of patients, and increases surgery related costs.
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Affiliation(s)
- Junhua Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Kaiwen Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shaohua Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shuzhe Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Rui Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Jiaming Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China.
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
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17
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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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18
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Geraldini F, De Cassai A, Correale C, Andreatta G, Grandis M, Navalesi P, Munari M. Predictors of deep-vein thrombosis in subarachnoid hemorrhage: a retrospective analysis. Acta Neurochir (Wien) 2020; 162:2295-2301. [PMID: 32577893 PMCID: PMC7311113 DOI: 10.1007/s00701-020-04455-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage is a severe subtype of hemorrhagic stroke, and deep-vein thrombosis is a frequent complication detected in these patients. In addition to other well-established risk factors, the early activation of coagulation systems present in patients with subarachnoid hemorrhage could potentially play a role in the incidence of deep-vein thrombosis. This study aims to identify possible predictors for deep-vein thrombosis related to subarachnoid hemorrhage. METHODS We conducted a retrospective cohort study on patients with a diagnosis of subarachnoid hemorrhage who presented to our institution between 1 January 2014 and 1 August 2018. We reviewed electronic medical records and analyzed several parameters such as Fisher scale, World Federation of Neurosurgical Surgeons scale, aneurysm site, surgical or endovascular treatment, decompressive craniectomy, vasospasm, infection (meningitis and pneumonia), presence of motor deficit, length of stay in the ICU, length of hospital stay, number of days under ventilator support, d-dimer at hospitalization, and the time to thromboprophylaxis (days). RESULTS The univariate analysis showed that intraparenchymal cerebral hemorrhage, d-dimer at hospitalization, the time to thromboprophylaxis, motor deficit, and aneurysm located at the internal carotid artery were statistically significant factors. Intraparenchymal cerebral hemorrhage (OR 2,78 95%CI 1.07-7.12), motor deficit (OR 3.46; 95%CI 1.37-9.31), and d-dimer at hospitalization (OR 1.002 95% CI 1.001-1.003) were demonstrated as independent risk factors for deep-vein thrombosis. Length of hospital stay was also found to be significantly longer in patients who developed deep-vein thrombosis (p value 0.018). CONCLUSION Elevated d-dimer level at the time of hospitalization, motor deficit, and the presence of an intraparenchymal hemorrhage are independent risk factors for deep-vein thrombosis. Patients with DVT also had a significantly longer hospital stay. Even though further studies are needed, patients with elevated d-dimer at hospitalization and intraparenchymal cerebral hemorrhage may benefit from a more aggressive screening strategy for deep-vein thrombosis.
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Affiliation(s)
- Federico Geraldini
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy.
| | - Alessandro De Cassai
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Christelle Correale
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Giulio Andreatta
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Marzia Grandis
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Paolo Navalesi
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Marina Munari
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
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Battaglini D, Brunetti I, Anania P, Fiaschi P, Zona G, Ball L, Giacobbe DR, Vena A, Bassetti M, Patroniti N, Schenone A, Pelosi P, Rocco PRM, Robba C. Neurological Manifestations of Severe SARS-CoV-2 Infection: Potential Mechanisms and Implications of Individualized Mechanical Ventilation Settings. Front Neurol 2020; 11:845. [PMID: 32903391 PMCID: PMC7434832 DOI: 10.3389/fneur.2020.00845] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
In December 2019, an outbreak of illness caused by a novel coronavirus (2019-nCoV, subsequently renamed SARS-CoV-2) was reported in Wuhan, China. Coronavirus disease 2019 (COVID-19) quickly spread worldwide to become a pandemic. Typical manifestations of COVID-19 include fever, dry cough, fatigue, and respiratory distress. In addition, both the central and peripheral nervous system can be affected by SARS-CoV-2 infection. These neurological changes may be caused by viral neurotropism, by a hyperinflammatory and hypercoagulative state, or even by mechanical ventilation-associated impairment. Hypoxia, endothelial cell damage, and the different impacts of different ventilatory strategies may all lead to increased stress and strain, potentially exacerbating the inflammatory response and leading to a complex interaction between the lungs and the brain. To date, no studies have taken into consideration the possible secondary effect of mechanical ventilation on brain recovery and outcomes. The aim of our review is to provide an updated overview of the potential pathogenic mechanisms of neurological manifestations in COVID-19, discuss the physiological issues related to brain-lung interactions, and propose strategies for optimization of respiratory support in critically ill patients with SARS-CoV-2 pneumonia.
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Affiliation(s)
- Denise Battaglini
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Iole Brunetti
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Pasquale Anania
- Department of Neurosurgery, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Pietro Fiaschi
- Department of Neurosurgery, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Gianluigi Zona
- Department of Neurosurgery, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Disease Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Antonio Vena
- Infectious Disease Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Matteo Bassetti
- Infectious Disease Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Nicolò Patroniti
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Ministry of Science, Technology, and Innovation, Brasília, Brazil.,Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
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A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1396705. [PMID: 32090066 PMCID: PMC7008289 DOI: 10.1155/2020/1396705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022]
Abstract
Objective This study aimed to explore the risk factors of urinary tract infection (UTI) in patients with intracranial cerebral hemorrhage (ICH). Design This is a retrospective study, and a total of 77 patients with ICH consecutively admitted to the First Affiliated Hospital of USTC (Anhui Provincial Hospital, Hefei, China) during the period of August 2015 to August 2017 were included. The patients were divided into an UTI group (24 cases) and a non-UTI group (53 cases); patients with UTI were diagnosed according to clinical manifestations, recent urinary routines, and urine culture results. The following information in these two groups was recorded: age, sex, course of disease, side of paralysis, location and type of cerebral hemorrhage, disturbance of consciousness or not, the Brunnstrom stage of paralysed lower limbs, number of basic diseases, whether there were complications (tracheotomy, retention catheterization, pulmonary infection, pressure sore, deep venous thrombosis, etc.), whether rehabilitation interventions were conducted, blood routine, biochemistry index, DIC complete set, urine routine, and urine culture data. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors of UTI in patients with ICH. Results Univariate analysis showed that age, side of paralysis, disturbance of consciousness, the Brunnstrom stage of lower limbs, tracheotomies, retention catheterization, pulmonary infection, leukocyte count, neutrophil proportion, sodium, uric acid, D-dimer, and fibrinogen may be related to UTI in patients with ICH (P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), Conclusions Increased age and high D-dimer are independent risk factors for UTI in patients with ICH, while right-sided paralysis is a protective factor for UTI in patients with ICH.
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21
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Ding D, Sekar P, Moomaw CJ, Comeau ME, James ML, Testai F, Flaherty ML, Vashkevich A, Worrall BB, Woo D, Osborne J. Venous Thromboembolism in Patients With Spontaneous Intracerebral Hemorrhage: A Multicenter Study. Neurosurgery 2019; 84:E304-E310. [PMID: 30011018 DOI: 10.1093/neuros/nyy333] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/19/2018] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Patients with spontaneous intracerebral hemorrhage (ICH) are predisposed to venous thromboembolic (VTE) complications, such as deep vein thrombosis and pulmonary embolism. OBJECTIVE To evaluate, in a multicenter, retrospective cohort study, the rate of VTE complications in ICH patients during acute hospitalization, identify potential risk factors, and assess their association with functional outcome. METHODS We retrospectively analyzed prospectively collected data from 19 centers and 41 sites that participated in the Ethnic/Racial Variations of Intracerebral Hemorrhage study, from August 2010 to February 2016. We compared ICH patients with VTE complications to those without VTE complications. Statistical analyses were performed to determine predictors of VTE complications and poor outcome (modified Rankin Scale ≥ 4) at discharge and 3-mo follow-up. RESULTS Of the 2902 ICH patients who were eligible for analysis, 87 (3.0%) had VTE complications: 57 (2.0%) had only deep vein thrombosis, 19 (0.7%) had only pulmonary embolism, and 11 (0.4%) had both. In the multivariable logistic regression analysis, a prior history of VTE (odds ratio [OR] = 6.8; P < .0001), intubation (OR = 4.0; P < .0001), and presence of IVH (OR = 1.8; P = .0157) were independent predictors of VTE complications. After controlling for ICH volume and location, IVH, age, and presenting Glasgow Coma Scale, the occurrence of VTE complications was an independent predictor of poor outcome at discharge (OR = 2.9; P = .002) and 3-mo follow-up (OR = 2.1; P = .02). CONCLUSION Although VTE complications are uncommon after ICH, they are associated with significantly worse outcomes. Further studies will be needed to determine the optimal treatment regimen for the prevention and treatment of VTE complications in ICH patients.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Padmini Sekar
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Charles J Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mary E Comeau
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Michael L James
- Departments of Anesthesiology and Neurology, Duke University, Durham, North Carolina
| | - Fernando Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois
| | - Matthew L Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Bradford B Worrall
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer Osborne
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
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22
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Diagnostic accuracy of biomarker D-dimer in patients after stroke suspected from venous thromboembolism: A diagnostic meta-analysis. Clin Biochem 2019; 63:126-134. [DOI: 10.1016/j.clinbiochem.2018.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 01/10/2023]
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Zhou Z, Liang Y, Zhang X, Xu J, Kang K, Qu H, Zhao C, Zhao M. Plasma D-Dimer Concentrations and Risk of Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:1114. [PMID: 30619067 PMCID: PMC6306414 DOI: 10.3389/fneur.2018.01114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/05/2018] [Indexed: 01/11/2023] Open
Abstract
Background: The aim of our meta-analysis was to evaluate the association between plasma d-dimer and intracerebral hemorrhage (ICH). Methods: Embase, Pubmed, and Web of Science were searched up to the date of March 19th, 2018, and manual searching was used to extract additional articles. Standard mean difference (SMD) with 95% confidence intervals (CI) was calculated to evaluate d-dimer levels. Results: Thirteen studies including 891 ICH patients and 1,573 healthy controls were included. Our results revealed that higher levels of d-dimer were displayed in ICH patients than those in healthy controls (95% CI= 0.98–2.00, p< 0.001). Subgroup analysis based on continent of Asia and Europe, sample size, as well as age in relation to d-dimer levels between ICH patients and healthy controls did not change the initial observation; whereas no differences of d-dimer levels were found between ICH and controls in America. Conclusions: This meta-analysis revealed that high level of d-dimer is associated with the risk of ICH. Plasma d-dimer is suggested to be a potential biomarker for patients with ICH in Asia and Europe rather than in America. There were no impact of sample size-related differences and age-related diversities on the risk of ICH with respect to d-dimer levels.
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Affiliation(s)
- Zhike Zhou
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yifan Liang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xiaoqian Zhang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Junjie Xu
- Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Kexin Kang
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Huiling Qu
- Department of Neurology, People's Hospital of Liaoning Province, Shenyang, China
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Mei Zhao
- Department of Cardiology, The Shengjing Affiliated Hospital, China Medical University, Shenyang, China
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24
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Zhou Z, Liang Y, Qu H, Zhao M, Guo F, Zhao C, Teng W. Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis. Sci Rep 2018; 8:2568. [PMID: 29416106 PMCID: PMC5803270 DOI: 10.1038/s41598-018-21019-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/29/2018] [Indexed: 12/27/2022] Open
Abstract
Intracerebral hemorrhage (ICH) has the highest mortality rate in all strokes. However, controversy still exists concerning the association between plasma homocysteine (Hcy) and ICH. A systematic review and meta-analysis was conducted using Pubmed, Embase, and Web of Science up to April 18, 2017. Standard mean difference (SMD) for mean differences of plasma Hcy levels with 95% confidence intervals (CI) was calculated. Seven studies including 667 ICH patients and 1821 ischemic stroke patients were identified for meta-analysis. Our results showed that Hcy levels in ICH patients were significantly higher than those in healthy controls (SMD = 0.59, 95% CI = 0.51–0.68, P < 0.001); no statistic differences were found in the comparisons of Hcy levels between ICH and ischemic stroke (SMD = −0.03, 95% CI = −0.13–0.06, P > 0.05); further subgroup analysis of ethnicity (Asians: SMD = 0.57, 95% CI = 0.48–0.66, P < 0.001; Caucasians: SMD = 0.77, 95% CI = 0.51–1.02, P < 0.001) and sample size (small samples: SMD = 0.55, 95% CI = 0.30–0.80, P < 0.001; large samples size: SMD = 0.60, 95% CI = 0.51–0.69, P < 0.001) in relation to Hcy levels between ICH and healthy controls did not change these results. In conclusion, Hcy level may be an aggravating factor in atherosclerosis, which is positively associated with high risk of ICH. Race-specific differences between Asians and Caucasians have no impact on the risk of ICH.
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Affiliation(s)
- Zhike Zhou
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China
| | - Yifan Liang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China
| | - Huiling Qu
- 3Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, 110016, Liaoning, PR China
| | - Mei Zhao
- Department of Cardiology, The Shengjing Affiliated Hospital, China Medical University, Shenyang, 110004, Liaoning, PR China
| | - Feng Guo
- Department of Neurology, Fuxin Central Hospital, fuxin, 123000, Liaoning, PR China
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China.
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