1
|
Wu X, Jiang Z, Xu D, Zhang R, Li H. Pre-thrombolysis serum sodium concentration is associated with post-thrombolysis symptomatic intracranial hemorrhage in ischemic stroke patients. Front Neurol 2024; 15:1341522. [PMID: 38882691 PMCID: PMC11178046 DOI: 10.3389/fneur.2024.1341522] [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: 11/27/2023] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background and aim Symptomatic intracranial hemorrhage (sICH) was the most serious complication associated with alteplase intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients. However, the relationship between serum sodium levels and post-thrombolysis symptomatic intracranial hemorrhage has not been investigated. Therefore, the aim of this study was to investigate the relationship between pre-thrombolysis serum sodium levels and sICH after IVT, as well as to explore the optimal pre-thrombolysis serum sodium levels for lowering the risk of sICH following IVT. Methods From July 1, 2017 to April 30, 2023, out-of-hospital AIS patients who received IVT in the emergency department were enrolled in this study. Serum sodium levels were measured at admission prior to IVT, and National Institutes of Health Stroke Scale scores were continuously assessed during and after thrombolysis. Routine follow-up neuroimaging was performed between 22 to 36 h after IVT. Initially, three logistic regression models and restricted cubic splines (RCS) were established to investigate the relationship between serum sodium levels and post-thrombolysis sICH. Furthermore, to evaluate the predictive value of serum sodium for post-thrombolysis sICH, we compared area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI) before and after incorporating serum sodium into traditional models. Finally, subgroup analysis was conducted to explore interactions between serum sodium levels and other variables. Results A total of 784 AIS patients who underwent IVT were enrolled, among whom 47 (6.0%) experienced sICH. The median serum sodium concentration for all patients was 139.10 [interquartile ranges (IQR): 137.40-141.00] mmol/L. Patients who developed sICH had lower serum sodium levels than those without sICH [138.20(IQR:136.00-140.20) vs. 139.20(IQR:137.40-141.00), p = 0.031]. Logistic regression analysis (model 3) revealed a 14% reduction in the risk of post-thrombolysis sICH for every 1 mmol/L increase in serum sodium levels after adjusting for confounding variables (p < 0.001). The risk of post-thrombolysis sICH was minimized within the serum sodium range of 139.1-140.9 mmol/L compared to serum sodium concentration below 137.0 mmol/L [odds ratio (OR) = 0.33, 95% confidence interval (CI): 0.13-0.81] in model3. Furthermore, there was a significant trend of decreasing risk for sICH as serum sodium concentrations increased across the four quartiles (P for trend = 0.036). The RCS analysis indicated a statistically significant reduction in the risk of sICH as serum sodium levels increased when the concentration was below 139.1 mmol/L. Incorporating serum sodium into traditional models improved their predictive performance, resulting in higher AUROC and NRI values. Subgroup analysis suggested that early infarct signs (EIS) appeared to moderate the relationship between serum sodium and sICH (p < 0.05). Conclusion Lower serum sodium levels were identified as independent risk factors for post-thrombolysis sICH. Maintaining pre-thrombolysis serum sodium concentrations above 139.1 mmol/L may help reduce the risk of post-thrombolysis sICH.
Collapse
Affiliation(s)
- Xiaolan Wu
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Zhuangzhuang Jiang
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Dongjuan Xu
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Rufang Zhang
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Hongfei Li
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| |
Collapse
|
2
|
Shen Y, Li D, Cao Q, Hu M, Hou Z, Xu L, Li Y, Hong D. Risk factors of vestibular migraine-related brain white matter lesions. Acta Neurol Belg 2023; 123:1833-1839. [PMID: 36071312 DOI: 10.1007/s13760-022-02076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/22/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE AND PURPOSE Migraine is related to white matter lesions (WMLs), and attack frequency and duration in migraine patients are thought to increase WMLs. However, the relationship between vestibular migraine (VM) and WMLs remains unclear. This study explored the risk factors for WMLs in VM patients and provided a basis for the prevention of WMLs in VM patients. METHODS A large single-center cross-sectional study of patients with VM was conducted. None of the patients had comorbidities, such as hypertension and diabetes, or adverse lifestyle habits (smoking and drinking). All patients were divided into WML + and WML- groups after assessment of WMLs using magnetic resonance imaging (MRI). After collecting the patient's detailed medical history, statistical analysis was performed. RESULTS In univariate analysis, the frequency of vertigo was statistically significant between the WML + and WML- groups. However, there was no significant difference in other clinical features. Multivariate regression analysis found that the frequency of vertigo (OR 2.399; 95% CI 1.014-5.679; p = 0.046) was an independent risk factor for WMLs. High frequency of vertigo episodes showed more pronounced risk factors (OR 9.607; 95% CI 1.061-87.014; p = 0.044). CONCLUSION These results substantiate that vertigo frequency is an independent risk factor for WMLs in VM. A high frequency of vertigo episodes is more likely to be associated with WMLs than a low frequency. These results suggest a possible approach to the prevention of WMLs in VM patients.
Collapse
Affiliation(s)
- Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17, Nanchang, Jiangxi, China
| | - Defu Li
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi, China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mengyao Hu
- The Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhou Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yanping Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17, Nanchang, Jiangxi, China.
| |
Collapse
|
3
|
Shen Y, Xiong Y, Cao Q, Li Y, Xiang W, Wang L, Nie Q, Tang B, Yang Y, Hong D. Construction and validation of a nomogram model to predict symptomatic intracranial hemorrhage after intravenous thrombolysis in severe white matter lesions. J Thromb Thrombolysis 2023:10.1007/s11239-023-02828-4. [PMID: 37193832 DOI: 10.1007/s11239-023-02828-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
Cerebral white matter lesions (WMLs) increase the risk of bleeding after intravenous thrombolysis (IVT) but are also considered to require IVT. Its risk factors and predictive models are still poorly studied. The aim of this study is to develop a clinically applicable model for post-IVT haemorrhage. It offers the possibility to prevent symptomatic intracranial hemorrhage (sICH) in patients with IVT in severe WMLs. A large single-center observational study conducted a retrospective analysis of IVT in patients with severe WMLs from January 2018 to December 2022. Univariate and multi-factor logistic regression results were used to construct nomogram model, and a series of validations were performed on the model. More than 2,000 patients with IVT were screened for inclusion in this study after cranial magnetic resonance imaging evaluation of 180 patients with severe WMLs, 28 of whom developed sICH. In univariate analysis, history of hypertension (OR 3.505 CI 2.257-4.752, p = 0.049), hyperlipidemia (OR 4.622 CI 3.761- 5.483, p < 0.001), the NIHSS score before IVT (OR 41.250 CI 39.212-43.288, p < 0.001), low-density lipoprotein levels (OR 1.995 CI 1.448-2.543, p = 0.013), cholesterol levels (OR 1.668 CI 1.246-2.090, p = 0.017), platelet count (OR 0.992 CI 0.985-0.999, p = 0.028), systolic blood pressure (OR 1.044 CI 1.022-1.066, p < 0.001), diastolic blood pressure (OR 1.047 CI 1.024-1.070, p < 0.001) were significantly associated with sICH. In a multifactorial analysis, the NIHSS score before IVT (OR 94.743 CI 92.311-97.175, p < 0.001), and diastolic blood pressure (OR 1.051 CI 1.005-1.097, p = 0.033) were considered to be significantly associated with sICH after IVT as risk factors for the occurrence of sICH. The four most significant factors from logistic regression are subsequently fitted to create a predictive model. The accuracy was verified using ROC curves, calibration curves, decision curves, and clinical impact curves, and the model was considered to have high accuracy (AUC 0.932, 95% 0.888-0.976). The NHISS score before IVT and diastolic blood pressure are independent risk factors for sICH after IVT in patients with severe WMLs. The models based on hyperlipidemia, the NIHSS score before IVT, low-density lipoprotein and diastolic blood pressure are highly accurate and can be applied clinically to provide a reliable predictive basis for IVT in patients with severe WMLs.
Collapse
Affiliation(s)
- Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Ying Xiong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - YanPing Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - WenWen Xiang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - LuLu Wang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Quirui Nie
- Department of Gerontology, Nanchang First Hospital, Nanchang, China
| | - BoJi Tang
- Department of Neurology, Xiamen Fifth People's Hospital, Xiamen, China
| | - YiRong Yang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China.
| |
Collapse
|
4
|
Sun J, Lam C, Christie L, Blair C, Li X, Werdiger F, Yang Q, Bivard A, Lin L, Parsons M. Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis. Front Neurol 2023; 14:1079205. [PMID: 36891475 PMCID: PMC9986457 DOI: 10.3389/fneur.2023.1079205] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Background Hemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)]. Methods Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated. Results A total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212-5.599, I 2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041-1.272, I 2 = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970-7.591, I 2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060-1.105, I 2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001-1.005, I 2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565-0.833, I 2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012-1.866, I 2 = 86.4%) were predictors of sICH after EVT. Conclusion Several predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.
Collapse
Affiliation(s)
- Jiacheng Sun
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christina Lam
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Lauren Christie
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Christopher Blair
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
| | - Xingjuan Li
- Queensland Department of Agriculture and Fisheries, Brisbane, QLD, Australia
| | - Freda Werdiger
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Qing Yang
- Apollo Medical Imaging Technology Pty Ltd., Melbourne, VIC, Australia
| | - Andrew Bivard
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Longting Lin
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mark Parsons
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
| |
Collapse
|