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Florez WA, Martinez-Perez R, Deora H, Joaquim AF, García-Ballestas E, Quiñones-Ossa GA, Rivas-Palacios C, Agrawal A, Serrato SA, Jabbour P, Moscote-Salazar LR. An update of predictors of cerebral infarction after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis. J Neurosurg Sci 2023; 67:1-9. [PMID: 36112119 DOI: 10.23736/s0390-5616.22.05445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Evidence about predictors of poor outcomes such as cerebral infarction (CI) after aneurysmal subarachnoid hemorrhage (aSAH) has not been fully elucidated. EVIDENCE ACQUISITION We performed a systematic review and meta-analysis on studies with adults with aSAH considering RCT and non-RCT, prospective, and retrospective cohort studies describing clinical, imaging as well as angiographic studies in patients with aSAH. EVIDENCE SYNTHESIS After reviewing the complete text, 11 studies were considered eligible, out of which four were ruled out. Degree of clinical severity was the most predictive factor with a higher degree at the presentation on different severity scales being associated with a statistically significant increasing the risk of suffering a CI following aSAH (OR 2.49 [95% CI 1.38-4.49] P=0.0003). Aneurysm size increased the risk of CI (OR 1.49 [95% CI 1.20-1.85] P=0.0003; I2=4%). In six studies analyzed, it was found that an important factor for the subsequent development of CI is vasospasm (OR 7.62 [2.19, 26.54], P=0.0001). CONCLUSIONS The development of vasospasm is a risk factor for CI development after aSAH. In our review, three factors were associated with an increased risk of CI: clinical severity at presentation, vasospasm, and aneurysm size. The major limitation of this meta-analysis is that included studies were conducted retrospectively or were post hoc analyses of a prospective trial.
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Affiliation(s)
- William A Florez
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia.,Faculty of Medicine, Universidad Surcolombiana, Neiva, Colombia
| | - Rafael Martinez-Perez
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.,Division of Neurosurgery, Institute of Neurosciences, Austral University of Chile, Valdivia, Chile
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Andrei F Joaquim
- Department of Neurosurgery. University of Campinas (UNICAMP), São Paulo, Brazil
| | - Ezequiel García-Ballestas
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia.,Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Gabriel A Quiñones-Ossa
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia - .,Faculty of Medicine, El Bosque University, Bogotá, Colombia
| | - Claudio Rivas-Palacios
- Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | | | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Luis R Moscote-Salazar
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia.,Faculty of Medicine, Universidad Surcolombiana, Neiva, Colombia
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Konar S, Florez-Perdomo W, Garcia-Ballestas E, Quiñones-Ossa GA, Janjua T, Moscote-Salazar LR, Mishra RK, Agrawal A. Blood pressure variability and prognosis in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg Sci 2023; 67:10-17. [PMID: 34647715 DOI: 10.23736/s0390-5616.21.05477-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The subarachnoid hemorrhage due to a ruptured brain aneurysm is a neurological emergency with high mobility and mortality. Hypertensive states are related to a bad prognosis and a higher risk of a ruptured aneurysm. However, the relationship between the blood pressure variability with the aneurysmal subarachnoid hemorrhage and its prognosis is quite unknown. EVIDENCE ACQUISITION A systematic review was performed across the databases. The following descriptors and related were used for the search: blood pressure, arterial pressure, variability, subarachnoid hemorrhage, hemorrhage, aneurysmal, aneurysmal subarachnoid hemorrhage. The following data were extracted: Glasgow Outcome Scale or Modified Rankin Scale, and blood pressure variabilities to categorize the prognosis. EVIDENCE SYNTHESIS Five studies were selected. The blood pressure variability and the related outcome were assessed by mean systolic blood pressure and minimum systolic blood. The meta-analysis of mean systolic blood pressure (cut-off >95.3 mmHg) showed an odds ratio of 11.23 (95% CI: 4.423 to 28.537) (P≤0.001), predicting the good outcome after the aneurysmal subarachnoid hemorrhage. The pooled analysis revealed AUC of the ROC predicting the good outcome was statistically significant (AUC: 0.85, P<0.001). The pooled data analysis of minimum systolic blood pressure revealed an odds ratio of 6.43 (95% CI: 2.834-14.589, P<0.001) and AUC of the pooled ROC 0.931 (95% CI: 0.851 to 1.000, P<0.001) to predict poor outcome. The funnel plot through Egger's test for the analysis showed different grades of asymmetry. CONCLUSIONS The blood pressure variability (mean and minimum systolic blood pressure) is a good predictor and parameter in the aneurysmal subarachnoid hemorrhage prognosis and outcome prediction.
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Affiliation(s)
- Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - William Florez-Perdomo
- Consejo Latinoamericano de Cuidado Neurocrítico (CLaNi), Cartagena, Colombia.,Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Ezequiel Garcia-Ballestas
- Consejo Latinoamericano de Cuidado Neurocrítico (CLaNi), Cartagena, Colombia.,Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Gabriel A Quiñones-Ossa
- Consejo Latinoamericano de Cuidado Neurocrítico (CLaNi), Cartagena, Colombia - .,Faculty of Medicine, El Bosque University, Bogotá, Colombia
| | | | - Luis R Moscote-Salazar
- Consejo Latinoamericano de Cuidado Neurocrítico (CLaNi), Cartagena, Colombia.,Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Rakesh K Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
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Thomas SM, Reindorp Y, Christophe BR, Connolly ES. Systematic Review of Resource Use and Costs in the Hospital Management of Intracerebral Hemorrhage. World Neurosurg 2022; 164:41-63. [PMID: 35489599 DOI: 10.1016/j.wneu.2022.04.055] [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: 12/10/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND While clinical guidelines provide a framework for hospital management of spontaneous intracerebral hemorrhage (ICH), variation in the resource use and costs of these services exists. We sought to perform a systematic literature review to assess the evidence on hospital resource use and costs associated with management of adult patients with ICH, as well as identify factors that impact variation in such hospital resource use and costs, regarding clinical characteristics and delivery of services. METHODS A systematic literature review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE(R) 1946 to present. Articles were assessed against inclusion and exclusion criteria. Study design, ICH sample size, population, setting, objective, hospital characteristics, hospital resource use and cost data, and main study findings were abstracted. RESULTS In total, 43 studies met the inclusion criteria. Pertinent clinical characteristics that increased hospital resource use included presence of comorbidities and baseline ICH severity. Aspects of service delivery that greatly impacted hospital resource consumption included intensive care unit length of stay and performance of surgical procedures and intensive care procedures. CONCLUSIONS Hospital resource use and costs for patients with ICH were high and differed widely across studies. Making concrete conclusions on hospital resources and costs for ICH care was constrained, given methodologic and patient variation in the studies. Future research should evaluate the long-term cost-effectiveness of ICH treatment interventions and use specific economic evaluation guidelines and common data elements to mitigate study variation.
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Affiliation(s)
- Steven Mulackal Thomas
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA.
| | - Yarin Reindorp
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Yang RP, Cai DK, Chen YX, Gang HN, Wei M, Zhu DQ, Li SM, Yang JM, Luo SN, Bi XL, Sun DM. Metabolic Insight Into the Neuroprotective Effect of Tao-He-Cheng-Qi (THCQ) Decoction on ICH Rats Using Untargeted Metabolomics. Front Pharmacol 2021; 12:636457. [PMID: 34012394 PMCID: PMC8126979 DOI: 10.3389/fphar.2021.636457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/21/2021] [Indexed: 01/01/2023] Open
Abstract
Tao-He-Cheng-Qi decoction (THCQ) is an effective traditional Chinese medicine used to treat intracerebral hemorrhage (ICH). This study was performed to investigate the possible neuroprotective effect of THCQ decoction on secondary brain damage in rats with intracerebral hemorrhage and to elucidate the potential mechanism based on a metabolomics approach. Sprague-Dawley (SD) rats were randomly divided into five groups: the sham group, collagenase-induced ICH model group, THCQ low-dose (THCQ-L)-treated group, THCQ moderate-dose (THCQ-M)-treated group and THCQ high-dose (THCQ-H)-treated group. Following 3 days of treatment, behavioral changes and histopathological lesions in the brain were estimated. Untargeted metabolomics analysis with multivariate statistics was performed by using ultrahigh-performance liquid chromatography–mass spectrometry (UPLC-Q-Exactive Orbitrap MS). THCQ treatment at two dosages (5.64 and 11.27 g/kg·d) remarkably improved behavior (p < 0.05), brain water content (BMC) and hemorheology (p < 0.05) and improved brain nerve tissue pathology and inflammatory infiltration in ICH rats. Moreover, a metabolomic analysis demonstrated that the serum metabolic profiles of ICH patients were significantly different between the sham group and the ICH-induced model group. Twenty-seven biomarkers were identified that potentially predict the clinical benefits of THCQ decoction. Of these, 4 biomarkers were found to be THCQ-H group-specific, while others were shared between two clusters. These metabolites are mainly involved in amino acid metabolism and glutamate-mediated cell excitotoxicity, lipid metabolism-mediated oxidative stress, and mitochondrial dysfunction caused by energy metabolism disorders. In addition, a correlation analysis showed that the behavioral scores, brain water content and hemorheology were correlated with levels of serum metabolites derived from amino acid and lipid metabolism. In conclusion, the results indicate that THCQ decoction significantly attenuates ICH-induced secondary brain injury, which could be mediated by improving metabolic disorders in cerebral hemorrhage rats.
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Affiliation(s)
- Rui-Pei Yang
- Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Da-Ke Cai
- Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Yu-Xing Chen
- Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Hai-Ning Gang
- Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Mei Wei
- Guangdong Yifang Pharmaceutical Co., Ltd. Foshan, China
| | - De-Quan Zhu
- Guangdong Yifang Pharmaceutical Co., Ltd. Foshan, China
| | - Su-Mei Li
- Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Jiu-Mei Yang
- Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Si-Ni Luo
- Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Xiao-Li Bi
- Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of T. C. M), Guangzhou, China
| | - Dong-Mei Sun
- Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Yifang Pharmaceutical Co., Ltd. Foshan, China
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