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Sipilä JOT. Adult-Onset Neuroepidemiology in Finland: Lessons to Learn and Work to Do. J Clin Med 2023; 12:3972. [PMID: 37373667 DOI: 10.3390/jcm12123972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Finland is a relatively small genetic isolate with a genetically non-homogenous population. Available Finnish data on neuroepidemiology of adult-onset disorders are limited, and this paper describes the conclusions that can be drawn and their implications. Apparently, Finnish people have a (relatively) high risk of developing Unverricht-Lundborg disease (EPM1), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Spinal muscular atrophy, Jokela type (SMAJ) and adult-onset dystonia. On the other hand, some disorders, such as Friedreich's ataxia (FRDA) and Wilson's disease (WD), are almost absent or completely absent in the population. Valid and timely data concerning even many common disorders, such as stroke, migraine, neuropathy, Alzheimer's disease and Parkinson's disease, are unavailable, and there are virtually no data on many less-common neurological disorders, such as neurosarcoidosis or autoimmune encephalitides. There also appear to be marked regional differences in the incidence and prevalence of many diseases, suggesting that non-granular nationwide data may be misleading in many cases. Concentrated efforts to advance neuroepidemiological research in the country would be of clinical, administrative and scientific benefit, but currently, all progress is blocked by administrative and financial obstacles.
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Affiliation(s)
- Jussi O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, 80210 Joensuu, Finland
- Clinical Neurosciences, Faculty of Medicine, University of Turku, 20014 Turku, Finland
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2
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Tian D, Zhang L, Zhuang Z, Huang T, Fan D. A two-sample Mendelian randomization analysis of modifiable risk factors and intracranial aneurysms. Sci Rep 2022; 12:7659. [PMID: 35538134 PMCID: PMC9091241 DOI: 10.1038/s41598-022-11720-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022] Open
Abstract
We aimed to investigate the causality between potentially modifiable risk factors and the risk of intracranial aneurysm. Genetic instruments for 51 modifiable factors and intracranial aneurysm data were obtained from recently published genome-wide association studies. We applied two-sample Mendelian randomization methods to investigate their causal relationships. Genetically predicted cigarettes per day, smoking initiation, systolic blood pressure, hypertension and body fat percentage were significantly associated with an increased risk of intracranial aneurysm [odds ratios (OR) 2.67, 95% confidence interval (CI) 1.75–4.07, p = 5.36 × 10–6, OR 1.53, 95% CI 1.32–1.77, p = 9.58 × 10–9, OR 1.05, 95% CI 1.02–1.08, p = 1.18 × 10–3, OR 1.65, 95% CI 1.19–2.28, p = 2.56 × 10–3 and OR 1.29, 95% CI 1.11–1.52, p = 1.33 × 10–3, respectively]. Type 2 diabetes mellitus was significantly associated with a decreased risk of intracranial aneurysm (OR 0.89, 95% CI 0.83–0.95, p = 8.54 × 10–4). Body fat percentage was significantly associated with subarachnoid haemorrhage (p = 5.70 × 10–5). This study provided genetic evidence of causal effects of smoking, blood pressure, type 2 diabetes mellitus and obesity on the risk of intracranial aneurysm.
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Affiliation(s)
- Danyang Tian
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Zhenhuang Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Rd., Haidian District, Beijing, 100191, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Rd., Haidian District, Beijing, 100191, China.
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China. .,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
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3
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Karhunen V, Bakker MK, Ruigrok YM, Gill D, Larsson SC. Modifiable Risk Factors for Intracranial Aneurysm and Aneurysmal Subarachnoid Hemorrhage: A Mendelian Randomization Study. J Am Heart Assoc 2021; 10:e022277. [PMID: 34729997 PMCID: PMC8751955 DOI: 10.1161/jaha.121.022277] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The aim of this study was to assess the associations of modifiable lifestyle factors (smoking, coffee consumption, sleep, and physical activity) and cardiometabolic factors (body mass index, glycemic traits, type 2 diabetes, systolic and diastolic blood pressure, lipids, and inflammation and kidney function markers) with risks of any (ruptured or unruptured) intracranial aneurysm and aneurysmal subarachnoid hemorrhage using Mendelian randomization. Methods and Results Summary statistical data for the genetic associations with the modifiable risk factors and the outcomes were obtained from meta‐analyses of genome‐wide association studies. The inverse‐variance weighted method was used as the main Mendelian randomization analysis, with additional sensitivity analyses conducted using methods more robust to horizontal pleiotropy. Genetic predisposition to smoking, insomnia, and higher blood pressure was associated with an increased risk of both intracranial aneurysm and aneurysmal subarachnoid hemorrhage. For intracranial aneurysm, the odds ratios were 3.20 (95% CI, 1.93–5.29) per SD increase in smoking index, 1.24 (95% CI, 1.10–1.40) per unit increase in log‐odds of insomnia, and 2.92 (95% CI, 2.49–3.43) per 10 mm Hg increase in diastolic blood pressure. In addition, there was weak evidence for associations of genetically predicted decreased physical activity, higher triglyceride levels, higher body mass index, and lower low‐density lipoprotein cholesterol levels with higher risk of intracranial aneurysm and aneurysmal subarachnoid hemorrhage, with 95% CI overlapping the null for at least 1 of the outcomes. All results were consistent in sensitivity analyses. Conclusions This Mendelian randomization study suggests that smoking, insomnia, and high blood pressure are major risk factors for intracranial aneurysm and aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Ville Karhunen
- Department of Epidemiology and Biostatistics School of Public Health Imperial College London London United Kingdom.,Research Unit of Mathematical Sciences University of Oulu Finland.,Center for Life Course Health Research University of Oulu Finland
| | - Mark K Bakker
- Department of Neurology and Neurosurgery University Medical Center Utrecht Brain CenterUtrecht University Utrecht the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery University Medical Center Utrecht Brain CenterUtrecht University Utrecht the Netherlands
| | - Dipender Gill
- Department of Epidemiology and Biostatistics School of Public Health Imperial College London London United Kingdom.,Clinical Pharmacology and Therapeutics Section Institute of Medical and Biomedical Education and Institute for Infection and Immunity St George's, University of London London United Kingdom.,Clinical Pharmacology Group, Pharmacy and Medicines Directorate St George's University Hospitals NHS Foundation Trust London United Kingdom.,Novo Nordisk Research Centre Oxford Oxford United Kingdom
| | - Susanna C Larsson
- Unit of Medical Epidemiology Department of Surgical Sciences Uppsala University Uppsala Sweden.,Unit of Cardiovascular and Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
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Toyota Y, Shishido H, Ye F, Koch LG, Britton SL, Garton HJL, Keep RF, Xi G, Hua Y. Hydrocephalus Following Experimental Subarachnoid Hemorrhage in Rats with Different Aerobic Capacity. Int J Mol Sci 2021; 22:4489. [PMID: 33925787 PMCID: PMC8123480 DOI: 10.3390/ijms22094489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/22/2022] Open
Abstract
Low aerobic capacity is considered to be a risk factor for stroke, while the mechanisms underlying the phenomenon are still unclear. The current study looked into the impacts of different aerobic capacities on early brain injury in a subarachnoid hemorrhage (SAH) model using rats bred for high and low aerobic capacity (high-capacity runners, HCR; low-capacity runners, LCR). SAH was modeled with endovascular perforation in HCR and LCR rats. Twenty-four hours after SAH, the rats underwent behavioral testing and MRI, and were then euthanized. The brains were used to investigate ventricular wall damage, blood-brain barrier breakdown, oxidative stress, and hemoglobin scavenging. The LCR rats had worse SAH grades (p < 0.01), ventricular dilatation (p < 0.01), ventricular wall damage (p < 0.01), and behavioral scores (p < 0.01). The periventricular expression of HO-1 and CD163 was significantly increased in LCR rats (p < 0.01 each). CD163-positive cells were co-localized with HO-1-positive cells. The LCR rats had greater early brain injuries than HCR rats. The LCR rats had more serious SAH and extensive ventricular wall damage that evolved more frequently into hydrocephalus. This may reflect changes in iron handling and neuroinflammation.
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Affiliation(s)
- Yasunori Toyota
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
| | - Hajime Shishido
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
| | - Fenghui Ye
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
| | - Lauren G. Koch
- Department of Physiology & Pharmacology, University of Toledo College of Medicine & Life Sciences, Toledo, OH 43614, USA;
| | - Steven L. Britton
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Hugh J. L. Garton
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
| | - Richard F. Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
| | - Ya Hua
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; (Y.T.); (H.S.); (F.Y.); (H.J.L.G.); (R.F.K.); (G.X.)
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Ou C, Liu J, Qian Y, Chong W, Zhang X, Liu W, Su H, Zhang N, Zhang J, Duan CZ, He X. Rupture Risk Assessment for Cerebral Aneurysm Using Interpretable Machine Learning on Multidimensional Data. Front Neurol 2021; 11:570181. [PMID: 33424738 PMCID: PMC7785850 DOI: 10.3389/fneur.2020.570181] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Assessment of cerebral aneurysm rupture risk is an important task, but it remains challenging. Recent works applying machine learning to rupture risk evaluation presented positive results. Yet they were based on limited aspects of data, and lack of interpretability may limit their use in clinical setting. We aimed to develop interpretable machine learning models on multidimensional data for aneurysm rupture risk assessment. Methods: Three hundred seventy-four aneurysms were included in the study. Demographic, medical history, lifestyle behaviors, lipid profile, and morphologies were collected for each patient. Prediction models were derived using machine learning methods (support vector machine, artificial neural network, and XGBoost) and conventional logistic regression. The derived models were compared with the PHASES score method. The Shapley Additive Explanations (SHAP) analysis was applied to improve the interpretability of the best machine learning model and reveal the reasoning behind the predictions made by the model. Results: The best machine learning model (XGBoost) achieved an area under the receiver operating characteristic curve of 0.882 [95% confidence interval (CI) = 0.838-0.927], significantly better than the logistic regression model (0.779; 95% CI = 0.729-0.829; P = 0.002) and the PHASES score method (0.758; 95% CI = 0.713-0.800; P = 0.001). Location, size ratio, and triglyceride level were the three most important features in predicting rupture. Two typical cases were analyzed to demonstrate the interpretability of the model. Conclusions: This study demonstrated the potential of using machine learning for aneurysm rupture risk assessment. Machine learning models performed better than conventional statistical model and the PHASES score method. The SHAP analysis can improve the interpretability of machine learning models and facilitate their use in a clinical setting.
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Affiliation(s)
- Chubin Ou
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jiahui Liu
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yi Qian
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Winston Chong
- Monash Medical Centre, Monash University, Clayton, VIC, Australia
| | - Xin Zhang
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wenchao Liu
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hengxian Su
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Zhang
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianbo Zhang
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuan-Zhi Duan
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuying He
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Abstract
Background and Purpose:
One of the largest twin studies to date suggested that subarachnoid hemorrhage (SAH) is mainly of nongenetic origin, but the causal effect of environmental factors on SAH is yet unknown. We hypothesized that if only one of the twins experience fatal SAH, they do not share the most important environmental risk factor for SAH, namely smoking. If true, such finding would suggest that smoking causes SAH.
Methods:
Through the nationwide cause-of-death register, we followed 16 282 same-sex twin pairs of Finnish origin from the older Finnish Twin Cohort between 1976 and 2018 and identified all participants who died from SAH. For the baseline, we collected risk factor information about smoking, hypertension, physical activity, body mass index, alcohol consumption, and education. We classified the pairs as monozygotic, dizygotic, or of unknown zygosity. We examined the within-pair risk factor differences in the pairs discordant for SAH, that is, where one twin died from SAH and the other did not. We computed both individual (whole cohort) and pairwise (discordant pair) hazard ratios and 95% CIs.
Results:
During the 869 469 person-years of follow-up, we identified 116 discordant and 2 concordant (both died from SAH) twin pairs for fatal SAH. Overall, 25 of the discordant twin pairs were monozygotic. For the whole cohort, smoking (occasional/current) was associated with increased risk of SAH death (hazard ratio, 3.33 [CI, 2.24–4.95]) as compared with nonsmokers (never/former). In the pairwise analyses for discordant twin pairs, we found that the twin who smoked had an increased risk of fatal SAH (hazard ratio, 6.33 [CI, 1.87–21.4]) as compared with the nonsmoking twin. The association remained consistent regardless of the twin pairs’ zygosity or sex.
Conclusions:
Our results provide strong evidence for a causal, rather than associative, role of smoking in SAH.
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Affiliation(s)
- Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Finland (I.R., M.K.)
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Finland (I.R., M.K.)
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland (J.K.)
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Na JH, Kim JH, Kang HI, Bae IS, Kim DR, Moon BG. Influence of Triggering Events on the Occurrence of Spontaneous Intracranial Hemorrhage : Comparison of Non-Lesional Spontaneous Intraparenchymal Hemorrhage and Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc 2020; 63:607-613. [PMID: 32883056 PMCID: PMC7477149 DOI: 10.3340/jkns.2020.0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Spontaneous intracranial hemorrhage is a life-threatening disease, and non-lesional spontaneous intraparenchymal hemorrhage (nIPH) and aneurysmal subarachnoid hemorrhage (aSAH) are the leading causes of spontaneous intracranial hemorrhage. Only a few studies have assessed the association between prior physical activity or triggering events and the occurrence of nIPH or aSAH. The purpose of this study is to investigate the role of specific physical activities and triggering events in the occurrence of nIPH and aSAH.
Methods We retrospectively reviewed 824 consecutive patients with spontaneous intracranial hemorrhage between January 2010 and December 2018. Among the 824 patients, 132 patients were excluded due to insufficient clinical data and other etiologies of spontaneous intracranial hemorrhage. The medical records of 692 patients were reviewed, and the following parameters were assessed : age, sex, history of hypertension, smoking, history of stroke, use of antiplatelet or anticoagulation agents, season and time of onset, physical activities performed according to the metabolic equivalents, and triggering event at onset. Events that suddenly raised the blood pressure such as sudden postural changes, defecation or urination, sexual intercourse, unexpected emotional stress, sauna bath, and medical examination were defined as triggering events. These clinical data were compared between the nIPH and aSAH groups.
Results Both nIPH and aSAH most commonly occurred during non-strenuous physical activity, and there was no significant difference between the two groups (p=0.524). Thirty-two patients (6.6%) in the nIPH group and 39 patients (8.1%) in the aSAH group experienced triggering events at onset, and there was a significant difference between the two groups (p=0.034). The most common triggering events were defecation or urination in both groups.
Conclusion Specific physical activity dose no affect the incidence of nIPH and aSAH. The relationship between the occurrence of intracranial hemorrhage and triggering events is higher in aSAH than nIPH.
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Affiliation(s)
- Jung Hyun Na
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Hee In Kang
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - In-Suk Bae
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Deok Ryeong Kim
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Byung Gwan Moon
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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He J, Zhang L, Yu Y, Luo X, Wei M, Chen G, Shen Y. Effects of clazosentan, cilostazol, and statins on aneurysmal subarachnoid hemorrhage: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19902. [PMID: 32332668 PMCID: PMC7440251 DOI: 10.1097/md.0000000000019902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a disease caused by the infiltration of blood into the subarachnoid space due to the rupture of an intracranial aneurysm. It is a serious cerebrovascular disease, with a mortality rate of about 40% worldwide, which seriously threatens human life and health. Many drugs are used to treat aSAH and its complications, and some have been tested in systematic reviews and have shown good effects. But which drug has the best effect remains unclear. This network meta-analysis (NMA) aims to assess the effectiveness and feasibility of clazosentan, cilostazol, and statins in patients with aSAH. METHODS We will search for EMBASE.com, PubMed, the Cochrane Library, and Web of Science from inception to December 2019. Randomized controlled trials (RCTs) reporting efficacy and safety of clazosentan, cilostazol, and statins compared with the control, or compared with each other for the treatment of aSAH will be included. Two independent reviewers will assess the risk of bias of the included RCTs with the Cochrane "Risk of bias" tool. The pairwise meta-analysis will be performed with the random-effects model. The NMA will be performed in a Bayesian hierarchical framework using Markov Chain Monte Carlo method in WinBUGS 1.4.3. Egger test and funnel plot will be used to assess the publication bias. We will evaluate the quality of evidence for each outcome according to the GRADE approach. RESULTS The results of this NMA will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will summarize up-to-date evidence to compare the efficacy and safety of clazosentan, cilostazol, and statins on aSAH.PROSPERO registration number: CRD42019147523.
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Affiliation(s)
- Junfang He
- Department of Neurological Rehabilitation, Rehabilitation Center Hospital of Gansu Province
| | - Li Zhang
- The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine
| | - Yao Yu
- Pathogens Biology Institute, School of Basic Medical Sciences of Lanzhou University
| | - Xinyue Luo
- The Second Clinical Medical College of Lanzhou University
| | - Min Wei
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou
| | - Gen Chen
- Pathogens Biology Institute, School of Basic Medical Sciences of Lanzhou University
- Basic Medical School, Guilin Medical University, Guilin
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