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Wu MJ, Dewi SRK, Hsu WT, Hsu TY, Liao SF, Chan L, Lin MC. Exploring Relationships of Heart Rate Variability, Neurological Function, and Clinical Factors with Mortality and Behavioral Functional Outcome in Patients with Ischemic Stroke. Diagnostics (Basel) 2024; 14:1304. [PMID: 38928719 PMCID: PMC11202750 DOI: 10.3390/diagnostics14121304] [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: 05/05/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Ischemic stroke is a leading cause of mortality and disability. The relationships of heart rate variability (HRV) and stroke-related factors with mortality and functional outcome are complex and not fully understood. Understanding these relationships is crucial for providing better insights regarding ischemic stroke prognosis. The objective of this study is to examine the relationship between HRV, neurological function, and clinical factors with mortality and 3-month behavioral functional outcome in ischemic stroke. We prospectively collected the HRV data and monitored the behavioral functional outcome of patients with ischemic stroke. The behavioral functional outcome was represented by a modified Rankin Scale (mRS) score. This study population consisted of 58 ischemic stroke patients (56.9% male; mean age 70) with favorable (mRS score ≤ 2) and unfavorable (mRS score ≥ 3) outcome. The analysis indicated that the median of the mean RR interval (RR mean) showed no statistical difference between mortality groups. Conversely, the median of the RR mean had significant association with unfavorable outcome (OR = 0.989, p = 0.007). Lower hemoglobin levels had significant association with unfavorable outcome (OR = 0.411, p = 0.010). Higher National Institute of Health Stroke Scale (NIHSS) score at admission had significant association with unfavorable outcome (OR = 1.396, p = 0.002). In contrast, age, stroke history, NIHSS score at admission, and hemoglobin showed no significant association with mortality in ischemic stroke. These results imply that HRV, as indicated by the median of RR mean, alongside specific clinical factors and neurological function at admission (measured by NIHSS score), may serve as potential prognostic indicators for 3-month behavioral functional outcome in ischemic stroke.
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Affiliation(s)
- Mei-Jung Wu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
- Nursing Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Sari R. K. Dewi
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
| | - Wan-Ting Hsu
- Nursing Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Tien-Yu Hsu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
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Ma K, Bebawy JF. Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature. Anesth Analg 2024; 138:992-1002. [PMID: 38109853 DOI: 10.1213/ane.0000000000006772] [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: 12/20/2023]
Abstract
Anemia is a highly prevalent condition that may compromise oxygen delivery to vital organs, especially among the critically ill. Although current evidence supports the adoption of a restrictive transfusion strategy and threshold among the nonbleeding critically ill patient, it remains unclear whether this practice should apply to the brain-injured patient, given the predisposition to cerebral ischemia in this patient population, in which even nonprofound anemia may exert a detrimental effect on clinical outcomes. The purpose of this review is to provide an overview of the pathophysiological changes related to impaired cerebral oxygenation in the brain-injured patient and to present the available evidence on the effect of anemia and varying transfusion thresholds on the clinical outcomes of patients with acute brain injury.
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Affiliation(s)
- Kan Ma
- From the Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John F Bebawy
- Department of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ramos JN, Calvão-Pires P, Gil I, Baptista T, Branco C, Branco G, Marto JP. Hemoglobin in large vessel occlusion: Look further than collaterals. J Clin Neurosci 2024; 121:100-104. [PMID: 38382284 DOI: 10.1016/j.jocn.2024.02.010] [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: 11/02/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Abnormal hemoglobin (Hb) levels lead to poorer outcomes in ischemic stroke, though the mechanisms remain elusive. We aimed to study the role of Hb on imaging and clinical outcomes, namely on collaterals as it is a known mediator of infarct growth. METHODS Retrospective cohort study of patients with large vessel occlusion ischemic stroke admitted to our center. Demographics, clinical and imaging variables were collected, particularly baseline hemoglobin, presence of anemia and collateral score. Collaterals were scored from 0 to 3 and defined as poor if 0-1. Multivariable analyses were performed for collateral score and clinical outcomes (3-month mortality and good prognosis). RESULTS We included 811 patients, 215 (26.5 %) with anemia. Patients with anemia were older, had more comorbidities and more severe strokes. Hemoglobin levels and anemia were not associated with collateral score (OR 0.97, 95 % CI 0.89-1.05, p = 0.414 and OR 0.89, 95 % CI 0.64-1.24, p = 0.487, respectively) nor with poor collaterals (OR 0.96, 95 % CI 0.88-1.05, p = 0.398 and OR 0.86, 95 % CI 0.60-1.23, p = 0.406, respectively). Hb levels were associated with 3-month mortality (OR 0.85, 95 % CI 0.76-0.96, p = 0.008). CONCLUSION Hemoglobin or anemia were not found to be associated with collateral status. Our results raise further questions regarding the pathophysiology of anemia and outcomes in ischemic stroke, highlighting the need for future research.
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Affiliation(s)
- João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
| | - Pedro Calvão-Pires
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Inês Gil
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Tiago Baptista
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Cristina Branco
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Gabriel Branco
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal; CEDOC, NOVA Medical School, Lisboa, Portugal
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Ceulemans A, Pinckaers FM, Postma AA, van Zwam WH, van Oostenbrugge RJ. Association Between Anemia and Clinical Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Treatment. J Stroke 2024; 26:87-94. [PMID: 38246723 PMCID: PMC10850445 DOI: 10.5853/jos.2023.01669] [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: 05/21/2023] [Revised: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND PURPOSE Endovascular treatment (EVT) is the preferred treatment option in eligible acute ischemic stroke (AIS) patients with a large vessel occlusion of the anterior circulation. Several comorbidities have been identified that can affect clinical outcomes. Various studies have investigated the association between anemia and clinical outcome and found conflicting. RESULTS . The aim is to investigate the association between pre-EVT anemia and clinical outcomes at different time points post-EVT, primarily focusing on the National Institutes of Health Stroke Scale (NIHSS) at 24-48 hours. METHODS We prospectively included 560 AIS patients who received EVT in the Maastricht University Medical Center+. Hemoglobin levels (Hb; g/dL) were determined on admission. Hb levels were also categorized into two groups: anemia (male: Hb ≤12.9 g/dL; female: Hb ≤11.9 g/dL) and no anemia. Multiple imputation was used to handle missing data. Multivariable regression was used to investigate the association between anemia or Hb levels and clinical outcomes. RESULTS Anemia was present in 26% of the patients. Multivariable regression did not show a significant association between anemia or Hb levels and NIHSS at 24-48 hours (adjusted β [aβ]anemia: 1.44, 95% confidence interval [CI]: -0.47 to 3.36; aβHb: -0.37, 95% CI: -0.88 to 0.13). However, multivariable regression showed significant associations with modified Rankin Scale (adjusted common odds ratio [acOR]anemia: 1.66, 95% CI: 1.12 to 2.48; acORHb: 0.83, 95% CI: 0.75 to 0.93) and poor functional outcome at 90 days (adjusted OR [aOR]anemia: 2.09, 95% CI: 1.21 to 3.63; aORHb: 0.80, 95% CI: 0.69 to 0.92). CONCLUSION Anemia was not independently associated with early neurological deficit (NIHSS) post-AIS, suggesting it is more suitable as a general frailty marker.
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Affiliation(s)
- Angelique Ceulemans
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Florentina M.E. Pinckaers
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Wim H. van Zwam
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Robert J. van Oostenbrugge
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Inui R, Koge J, Tanaka K, Yoshimoto T, Shiozawa M, Abe S, Ishiyama H, Imamura H, Nakahara J, Kataoka H, Ihara M, Toyoda K, Koga M. Detrimental effect of anemia after mechanical thrombectomy on functional outcome in patients with ischemic stroke. Front Neurol 2023; 14:1299891. [PMID: 38187149 PMCID: PMC10770243 DOI: 10.3389/fneur.2023.1299891] [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: 09/23/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background Anemia can occur due to an aspiration maneuver of blood with thrombi during mechanical thrombectomy (MT) for stroke. However, the association between postoperative anemia and stroke outcomes is unknown. Methods In a registry-based hospital cohort, consecutive patients with acute ischemic stroke who underwent MT were retrospectively recruited. Patients were divided into the following three groups according to their hemoglobin (Hb) concentrations within 24 h after MT; no anemia (Hb concentrations ≥13 g/dL for men and ≥ 12 g/dL for women), mild anemia (Hb concentrations of 11-13 g/dL and 10-12 g/dL, respectively), and moderate-to-severe anemia (Hb concentrations <11 g/dL and < 10 g/dL, respectively). A 3-month modified Rankin Scale score of 0-2 indicated a favorable outcome. Results Of 470 patients, 166 were classified into the no anemia group, 168 into the mild anemia group, and 136 into the moderate-to-severe anemia group. Patients in the moderate-to-severe anemia group were older and more commonly had congestive heart failure than those in the other groups. Patients in the moderate-to-severe anemia group also had more device passes than those in the other groups (p < 0.001). However, no difference was observed in the rate of final extended thrombolysis in cerebral infarction ≥2b reperfusion or intracranial hemorrhage among the groups. A favorable outcome was less frequently achieved in the moderate-to-severe anemia group than in the no anemia group (adjusted odds ratio, 0.46; 95% confidence interval, 0.26-0.81) independent of the baseline Hb concentration. A restricted cubic spline model with three knots showed that the adjusted odds ratio for a favorable outcome was lower in patients with lower Hb concentrations within 24 h after MT. Conclusion Moderate-to-severe anemia within 24 h after MT is independently associated with a reduced likelihood of a favorable outcome. Clinical trial registration https://www.clinicaltrials.gov, NCT02251665.
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Affiliation(s)
- Ryoma Inui
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soichiro Abe
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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Chen H, Ahmad G, Phipps MS, Colasurdo M, Miller TR, Cherian J, Wozniak MA, Tran QK, Gandhi D, Chaturvedi S, Jindal G. Peri-procedural decrease in hemoglobin following mechanical thrombectomy for ischemic stroke. Interv Neuroradiol 2023:15910199231205627. [PMID: 37796790 DOI: 10.1177/15910199231205627] [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: 10/07/2023] Open
Abstract
BACKGROUND Peri-procedural blood loss and hemodilution occur in patients undergoing mechanical thrombectomy (MT) for ischemic stroke; however, its relationships with thrombectomy passes, procedure times, and clinical outcomes are unknown. METHODS Consecutive patients undergoing MT for anterior circulation large-vessel occlusion ischemic strokes were identified at a Comprehensive Stroke Center. Clinical information, modified treatment in cerebral ischemia (mTICI) scores, and modified Rankin Scores (mRS) at 90 days were prospectively collected from 2012 to 2021. Hemoglobin measurements before and after MTs were collected retrospectively via chart review, and changes were quantified. Patients with new-onset severe anemia (defined as post-MT hemoglobin less than 10g/dL) were identified. Modified Rankin scale (mRS) at 90 days was used to measure clinical outcomes. RESULTS Four-hundred and forty-five patients were identified. Hemoglobin decreased 1.27 ± 1.05 g/dL after MT on average. Greater number of thrombectomy passes and longer procedure times were associated with larger decreases in hemoglobin (p < 0.001 and p = 0.002, respectively). 11.5% (51 of 445) of patients had new-onset severe anemia, and this incidence was significantly higher with more thrombectomy passes (6.4% for one pass, 11.9% for two passes, and 17.4% for three or more passes; p = 0.010). In multivariable analyses, new-onset severe anemia was associated with significantly higher odds of 90-day poor outcomes (mRS 3-6, OR 2.70 [95%CI 1.12-6.51], p = 0.027) and death (OR 2.73 [95%CI 1.06-7.04], p = 0.037) compared to mild post-MT anemia. CONCLUSIONS More thrombectomy passes and longer procedure times were significantly associated with larger peri-procedural decreases in hemoglobin. Patients with new-onset hemoglobin less than 10 g/dL are at risk of poor outcomes.
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Affiliation(s)
- Huanwen Chen
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ghasan Ahmad
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Michael S Phipps
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Marco Colasurdo
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Timothy R Miller
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Quincy K Tran
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
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Fujiwara S, Sakai N, Imamura H, Ohara N, Tanaka K, Yamagami H, Matsumoto Y, Takeuchi M, Uchida K, Yoshimura S, Morimoto T. Association between anemic status on admission and clinical outcomes of acute large vessel occlusion. J Neurol Sci 2022; 440:120343. [PMID: 35872473 DOI: 10.1016/j.jns.2022.120343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/20/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anemia is a frequently observed condition, but its clinical impact on large vessel occlusion (LVO) remains unclear. We examined the association between anemic status on admission and clinical outcomes of LVO in a real-world setting. METHODS We conducted a post-hoc analysis of the RESCUE-Japan Registry 2, a nationwide registry which enrolled 2408 consecutive patients with LVO who were admitted within 24 h of onset. The patients were classified into anemia (<11 g/dL) and no-anemia (≥11 g/dL) groups according to their hemoglobin level on admission. The primary outcome was defined as a modified Rankin Scale of 0-2 at day 90. RESULTS Among the 2373 patients with available baseline hemoglobin data, 307 (13.0%) were classified in the anemia group. Anemia was associated with a lower likelihood of the primary outcome (adjusted odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.47-0.98) and higher mortality within 90 days (adjusted OR: 1.48; 95% CI: 1.01-2.17). Subgroup analyses showed that the likelihood of achieving the primary outcome between the two groups was different between men and women (P for interaction = 0.049), those with Alberta Stroke Program Early CT Score (ASPECTS) <6 and ASPECTS ≥6 (P for interaction = 0.02), and those with National Institute of Health Stroke Scale (NIHSS) ≥16 and NIHSS < 16 (P for interaction = 0.005). CONCLUSIONS Anemic state on admission was associated with poorer clinical outcomes of LVO in real-world clinical practice. The effects of anemic status were larger in LVO patients with lower NIHSS or higher ASPECTS.
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Affiliation(s)
- Satoru Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Miyagi, Japan
| | | | - Kazutaka Uchida
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
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Qu S, Zhou M, Jiao S, Zhang Z, Xue K, Long J, Zha F, Chen Y, Li J, Yang Q, Wang Y. Optimizing acute stroke outcome prediction models: Comparison of generalized regression neural networks and logistic regressions. PLoS One 2022; 17:e0267747. [PMID: 35544482 PMCID: PMC9094516 DOI: 10.1371/journal.pone.0267747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Generalized regression neural network (GRNN) and logistic regression (LR) are extensively used in the medical field; however, the better model for predicting stroke outcome has not been established. The primary goal of this study was to compare the accuracies of GRNN and LR models to identify the most optimal model for the prediction of acute stroke outcome, as well as explore useful biomarkers for predicting the prognosis of acute stroke patients. Method In a single-center study, 216 (80% for the training set and 20% for the test set) acute stroke patients admitted to the Shenzhen Second People’s Hospital between December 2019 to June 2021 were retrospectively recruited. The functional outcomes of the patients were measured using Barthel Index (BI) on discharge. A training set was used to optimize the GRNN and LR models. The test set was utilized to validate and compare the performances of GRNN and LR in predicting acute stroke outcome based on the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and the Kappa value. Result The LR analysis showed that age, the National Institute Health Stroke Scale score, BI index, hemoglobin, and albumin were independently associated with stroke outcome. After validating in test set using these variables, we found that the GRNN model showed a better performance based on AUROC (0.931 vs 0.702), sensitivity (0.933 vs 0.700), specificity (0.889 vs 0.722), accuracy (0.896 vs 0.729), and the Kappa value (0.775 vs 0.416) than the LR model. Conclusion Overall, the GRNN model demonstrated superior performance to the LR model in predicting the prognosis of acute stroke patients. In addition to its advantage in not affected by implicit interactions and complex relationship in the data. Thus, we suggested that GRNN could be served as the optimal statistical model for acute stroke outcome prediction. Simultaneously, prospective validation based on more variables of the GRNN model for the prediction is required in future studies.
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Affiliation(s)
- Sheng Qu
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Shengxiu Jiao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Zeyu Zhang
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Kaiwen Xue
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Fubing Zha
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Yuan Chen
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Jiehui Li
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Qingqing Yang
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
- * E-mail:
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Ng S, Zhu QF, Jiang JB, Liu CH, Fan JQ, Xu YM, Liu XB, Wang JA. Anemia and risk of periprocedural cerebral injury detected by diffusion-weighted magnetic resonance imaging in patients undergoing transcatheter aortic valve replacement. World J Emerg Med 2022; 13:32-39. [PMID: 35003413 PMCID: PMC8677916 DOI: 10.5847/wjem.j.1920-8642.2022.025] [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: 05/21/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anemia is prevalent in patients undergoing transcatheter aortic valve replacement (TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR. METHODS We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging (DW-MRI) procedure before and within 4-7 days after TAVR. RESULTS Anemia was present in 85 (53.8%) patients who underwent TAVR, and 126 (79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia (P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery (ACA/MCA) and MCA regions compared to the non-anemic patients (31.89±55.78 mm3 vs. 17.08±37.39 mm3, P=0.049; and 54.54±74.72 mm3 vs. 33.75±46.03 mm3, P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA (β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone (β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.
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Affiliation(s)
- Stella Ng
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Qi-feng Zhu
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ju-bo Jiang
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Chun-hui Liu
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jia-qi Fan
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ye-ming Xu
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xian-bao Liu
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jian-an Wang
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
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10
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Tatlisumak T, Putaala J. General Stroke Management and Stroke Units. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Zhang R, Xu Q, Wang A, Jiang Y, Meng X, Zhou M, Wang Y, Liu G. Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack. J Am Heart Assoc 2021; 10:e022547. [PMID: 34845923 PMCID: PMC9075388 DOI: 10.1161/jaha.121.022547] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.
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Affiliation(s)
- Runhua Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China.,Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
| | - Qin Xu
- Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
| | - Anxin Wang
- Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
| | - Yong Jiang
- Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
| | - Xia Meng
- Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China
| | - Yongjun Wang
- Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
| | - Gaifen Liu
- Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China
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12
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Association of anemia with functional outcomes in patients with mechanical thrombectomy. Clin Neurol Neurosurg 2021; 211:107028. [PMID: 34826754 DOI: 10.1016/j.clineuro.2021.107028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anemia at presentation is associated with worse outcomes in patients with acute ischemic stroke (AIS). We aim to investigate the association of anemia parameters with functional dependence and mortality in patients who undergo mechanical thrombectomy (MT). METHODS We performed a retrospective chart review of patients who underwent MT for an anterior circulation large vessel occlusion at a comprehensive stroke center from 1/2015-6/2020. Anemia was considered as a dichotomous categorical variable with a cutoff point of hemoglobin (Hb) < 12.0 g/dL in women and < 13.0 g/dL in men, as per the definition of the World Health Organization. Mean values of Hb and hematocrit (HCT) were obtained over the first five days of admission. Hemoglobin and HCT variability were measured using standard deviation (SD), and coefficient variability (CV) over the first five days of admission. Values of variance and difference (the difference between peak and trough of Hemoglobin or HCT) were also recorded. Multivariate logistic regression analyses were performed, including the predictor variables which were contributing significantly to the model (P < 0.05) in the univariate analysis, with 30-day functional dependence (mRS 3-6) (primary outcome) and 30-day mortality (secondary outcome) as the dependent variables. RESULTS 188 patients met our inclusion criteria. Anemia on presentation, lower mean and minimum values of five-day Hb and HCT, and higher variability in five-day Hb and HCT parameters were associated with higher 3-month mortality. Men with lower mean and minimum values of five-day Hb and HCT had a significantly higher likelihood of functional dependence at 3-months. This finding was not replicated amongst women in our cohort. CONCLUSION Our study demonstrated higher 3-mortality in patients with anemia and Hb variability. Our study also demonstrated a higher likelihood of functional dependence in patients amongst men with anemia.
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13
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Abstract
PURPOSE OF THE REVIEW Anemia has been called the fifth cardiovascular risk factor. It is one of the most prevalent pathologies worldwide. In this article, we aimed to perform a narrative review of the main cerebrovascular complications of anemia and its influence on stroke prognosis. RECENT FINDINGS Both hypoproliferative anemia (thalassemia, iron deficiency anemia, etc.) and hyperproliferative anemia (sickle cell disease, paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis, etc.) are associated to cerebrovascular disease ranging from transient ischemic attack to ischemic stroke and hemorrhagic stroke with both intraparenchymal hemorrhage and subarachnoid hemorrhage or cerebral venous thrombosis. Anemia is associated to a worse prognosis in patients with cerebrovascular disease In some cases, like sickle cell disease, pathophysiological mechanisms and therapeutic guidelines are well established, while in others, due to their rarity, there are still lack of robust data. More studies are needed to clarify how the prognosis of stroke patients with anemia could be improved.
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14
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Benesch C, Glance LG, Derdeyn CP, Fleisher LA, Holloway RG, Messé SR, Mijalski C, Nelson MT, Power M, Welch BG. Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association. Circulation 2021; 143:e923-e946. [PMID: 33827230 DOI: 10.1161/cir.0000000000000968] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.
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15
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Abstract
PURPOSE OF REVIEW Abrupt blood pressure (BP) rise is the most common clinical symptom of acute ischemic stroke (AIS). However, BP alterations during AIS reflect many diverse mechanisms, both stroke-related and nonspecific epiphenomena, which change over time and across patients. While extremes of BP as well as high BP variability have been related with worse outcomes in observational studies, optimal BP management after AIS remains challenging. RECENT FINDINGS This review discusses the complexity of the factors linking BP changes to the clinical outcomes of patients with AIS, depending on the treatment strategy and local vessel status and, in particular, the degree of reperfusion achieved. The evidence for possible additional clinical markers, including the presence of arterial hypertension, and comorbid organ dysfunction in individuals with AIS, as informative and helpful factors in therapeutic decision-making concerning BP will be reviewed, as well as recent data on neurovascular monitoring targeting person-specific local cerebral perfusion and metabolic demand, instead of the global traditional parameters (BP among others) alone. The individualization of BP management protocols based on a complex evaluation of the homeostatic response to focal cerebral ischemia, including but not limited to BP changes, may be a valuable novel goal proposed in AIS, but further trials are warranted.
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Affiliation(s)
- Dariusz Gąsecki
- Department of Adult Neurology, Medical University of Gdańsk, ul, Dębinki 7, 80-952, Gdańsk, Poland.
| | - Mariusz Kwarciany
- Department of Adult Neurology, Medical University of Gdańsk, ul, Dębinki 7, 80-952, Gdańsk, Poland
| | - Kamil Kowalczyk
- Department of Adult Neurology, Medical University of Gdańsk, ul, Dębinki 7, 80-952, Gdańsk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, ul, Dębinki 7, 80-952, Gdańsk, Poland
| | - Bartosz Karaszewski
- Department of Adult Neurology, Medical University of Gdańsk, ul, Dębinki 7, 80-952, Gdańsk, Poland
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16
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Ben Hassen W, Tordjman M, Boulouis G, Bretzner M, Bricout N, Legrand L, Benzakoun J, Edjlali M, Seners P, Cordonnier C, Oppenheim C, Turc G, Henon H, Naggara O. Benefit of first-pass complete reperfusion in thrombectomy is mediated by limited infarct growth. Eur J Neurol 2020; 28:124-131. [PMID: 32896067 DOI: 10.1111/ene.14490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE The number of clot retrieval attempts required to achieve complete reperfusion by mechanical thrombectomy impacts functional outcome in acute ischaemic stroke (AIS). Complete reperfusion [expanded Treatment In Cerebral Infarction (eTICI) score = 3] at first pass (FP), is associated with the highest rates of favorable outcome compared to complete reperfusion by multiple passes. The aim of the present study was to investigate the relationship between FP complete reperfusion and infarct growth (IG). METHODS Anterior AIS patients with baseline and 24-h diffusion-weighted magnetic resonance imaging were included from two prospective registries. IG was measured by voxel-based segmentation of initial and 24-h diffusion-weighted imaging lesions. IG and favorable 3-month modified Rankin Scale (mRS) score (≤ 2) were compared between patients in whom complete reperfusion (eTICI 3) was achieved with a single pass (FP group) and those for whom multiple passes were required (MP group), after matching for confounding factors. Mediation analysis was performed to examine the association between FP and 3-month mRS score, with IG as mediating variable. RESULTS A total of 200 patients were included, of whom 118 (28.9%) had FP complete reperfusion. In case-control analysis, the FP group had lower IG than the MP group [8.7 (5.4-12.9) ml vs. 15.2 (11-22.6) ml, respectively; P = 0.03). Favorable outcome was higher in the FP population compared to a matched MP population (70.9% vs. 53.2%, respectively; P = 0.04). FP compete reperfusion (eTICI 3) was independently associated with favorable outcome in multivariable regression analysis [odds ratio 1.86, 95% confidence interval (CI) 1.01-4.39; P = 0.04]. The effect of complete reperfusion at FP on functional outcome was explained by limited IG in mediation analysis [indirect effect: -0.32 (95% CI -0.47 to -0.09)]. CONCLUSION Complete reperfusion at FP is independently associated with significant decrease in IG compared to complete reperfusion by multiple attempts, explaining better functional outcomes.
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Affiliation(s)
- W Ben Hassen
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Tordjman
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - G Boulouis
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Bretzner
- Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - N Bricout
- Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - L Legrand
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - J Benzakoun
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Edjlali
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - P Seners
- Department of Neurology, CH Sainte-Anne, Paris, France
| | - C Cordonnier
- Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - C Oppenheim
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - G Turc
- Department of Neurology, CH Sainte-Anne, Paris, France
| | - H Henon
- Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - O Naggara
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
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17
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Ebogo Fouda Elodie D, Gams Massi D, Kenmegne C, Ngouadjeu E, Mapoure YN. Impact pronostic du taux d’hémoglobine de la phase aiguë des accidents ischémiques cérébraux en Afrique Subsaharienne. Rev Neurol (Paris) 2020. [DOI: 10.1016/j.neurol.2020.01.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Altersberger VL, Kellert L, Al Sultan AS, Martinez-Majander N, Hametner C, Eskandari A, Heldner MR, van den Berg SA, Zini A, Padjen V, Kägi G, Pezzini A, Polymeris A, DeMarchis GM, Tiainen M, Räty S, Nannoni S, Jung S, Zonneveld TP, Maffei S, Bonati L, Lyrer P, Sibolt G, Ringleb PA, Arnold M, Michel P, Curtze S, Nederkoorn PJ, Engelter ST, Gensicke H. Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients. Eur Stroke J 2020; 5:138-147. [PMID: 32637647 PMCID: PMC7313367 DOI: 10.1177/2396987319889468] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/21/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Alterations in haemoglobin levels are frequent in stroke patients. The prognostic meaning of anaemia and polyglobulia on outcomes in patients treated with intravenous thrombolysis is ambiguous. PATIENTS AND METHODS In this prospective multicentre, intravenous thrombolysis register-based study, we compared haemoglobin levels on hospital admission with three-month poor outcome (modified Rankin Scale 3-6), mortality and symptomatic intracranial haemorrhage (European Cooperative Acute Stroke Study II-criteria (ECASS-II-criteria)). Haemoglobin level was used as continuous and categorical variable distinguishing anaemia (female: <12 g/dl; male: <13 g/dl) and polyglobulia (female: >15.5 g/dl; male: >17 g/dl). Anaemia was subdivided into mild and moderate/severe (female/male: <11 g/dl). Normal haemoglobin level (female: 12.0-15.5 g/dl, male: 13.0-17.0 g/dl) served as reference group. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated with logistic regression models. RESULTS Among 6866 intravenous thrombolysis-treated stroke patients, 5448 (79.3%) had normal haemoglobin level, 1232 (17.9%) anaemia - of those 903 (13.2%) had mild and 329 (4.8%) moderate/severe anaemia - and 186 (2.7%) polyglobulia. Anaemia was associated with poor outcome (ORadjusted 1.25 (1.05-1.48)) and mortality (ORadjusted 1.58 (1.27-1.95)). In anaemia subgroups, both mild and moderate/severe anaemia independently predicted poor outcome (ORadjusted 1.29 (1.07-1.55) and 1.48 (1.09-2.02)) and mortality (ORadjusted 1.45 (1.15-1.84) and ORadjusted 2.00 (1.46-2.75)). Each haemoglobin level decrease by 1 g/dl independently increased the risk of poor outcome (ORadjusted 1.07 (1.02-1.11)) and mortality (ORadjusted 1.08 (1.02-1.15)). Anaemia was not associated with occurrence of symptomatic intracranial haemorrhage. Polyglobulia did not change any outcome. DISCUSSION The more severe the anaemia, the higher the probability of poor outcome and death. Severe anaemia might be a target for interventions in hyperacute stroke. CONCLUSION Anaemia on admission, but not polyglobulia, is a strong and independent predictor of poor outcome and mortality in intravenous thrombolysis-treated stroke patients.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lars Kellert
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ashraf Eskandari
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sophie A van den Berg
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrea Zini
- Stroke Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena, Italy
| | - Visnja Padjen
- Neurology Clinic, Clinical Centre of Serbia, Beograd, Serbia
| | - Georg Kägi
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Alexandros Polymeris
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian M DeMarchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marjaana Tiainen
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Silja Räty
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stefania Nannoni
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas P Zonneveld
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Stefania Maffei
- Stroke Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena, Italy
| | - Leo Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gerli Sibolt
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
| | - for the Thrombolysis in Stroke Patients (TRISP) collaborators
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Stroke Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena, Italy
- Neurology Clinic, Clinical Centre of Serbia, Beograd, Serbia
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
- Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
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Timing of Transfusion, not Hemoglobin Variability, is Associated with 3-Month Outcomes in Acute Ischemic Stroke. J Clin Med 2020; 9:jcm9051566. [PMID: 32455835 PMCID: PMC7290978 DOI: 10.3390/jcm9051566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: This study aimed to investigate whether transfusions and hemoglobin variability affects the outcome of stroke after an acute ischemic stroke (AIS). METHODS We studied consecutive patients with AIS admitted in three tertiary hospitals who received red blood cell (RBC) transfusion (RBCT) during admission. Hemoglobin variability was assessed by minimum, maximum, range, median absolute deviation, and mean absolute change in hemoglobin level. Timing of RBCT was grouped into two categories: admission to 48 h (early) or more than 48 h (late) after hospitalization. Late RBCT was entered into multivariable logistic regression model. Poor outcome at three months was defined as a modified Rankin Scale score ≥3. RESULTS Of 2698 patients, 132 patients (4.9%) received a median of 400 mL (interquartile range: 400-840 mL) of packed RBCs. One-hundred-and-two patients (77.3%) had poor outcomes. The most common cause of RBCT was gastrointestinal bleeding (27.3%). The type of anemia was not associated with the timing of RBCT. Late RBCT was associated with poor outcome (odd ratio (OR), 3.55; 95% confidence interval (CI), 1.43-8.79; p-value = 0.006) in the univariable model. After adjusting for age, sex, Charlson comorbidity index, and stroke severity, late RBCT was a significant predictor (OR, 3.37; 95% CI, 1.14-9.99; p-value = 0.028) of poor outcome at three months. In the area under the receiver operating characteristics curve comparison, addition of hemoglobin variability indices did not improve the performance of the multivariable logistic model. CONCLUSION Late RBCT, rather than hemoglobin variability indices, is a predictor for poor outcome in patients with AIS.
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20
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He W, Ruan Y, Yuan C, Luan X, He J. Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study. Int J Geriatr Psychiatry 2020; 35:564-571. [PMID: 31994213 DOI: 10.1002/gps.5272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/21/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Several studies have demonstrated that anemia was associated with cognitive impairment. The aim of this study was to explore the relationship between hemoglobin and cognitive impairment in patient with acute ischemic stroke. METHODS In total, 326 patients with acute ischemic stroke were followed up for 1 month. The main outcome was the incidence and severity of poststroke cognitive impairment (PSCI) assessed by Mini-Mental State Examination (MMSE). The impact of hemoglobin levels and anemia on PSCI was assessed by multiple regression models controlling for potential confounders. RESULTS During the 1-month follow-up, 193 (59.2%) patients developed PSCI. Anemia was independently associated with PSCI (OR = 3.637; 95% CI, 1.216-10.881; P = .021) after adjusting for demographics, vascular risk factors, stroke severity, and functional outcome. When the hemoglobin levels stratified into tertiles, higher hemoglobin levels were associated with better cognitive function. This result was however not significant after adjusting for the same confounders above. CONCLUSIONS Low hemoglobin levels are associated with an increased risk of PSCI. Targeted interventions in this population may reduce the incidence of PSCI and require further evaluation.
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Affiliation(s)
- Weilei He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiting Ruan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengxiang Yuan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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21
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Silvis SM, Reinstra E, Hiltunen S, Lindgren E, Heldner MR, Mansour M, Ghiasian M, Jood K, Zuurbier SM, Groot AE, Arnold M, Barboza MA, Arauz A, Putaala J, Tatlisumak T, Coutinho JM. Anaemia at admission is associated with poor clinical outcome in cerebral venous thrombosis. Eur J Neurol 2020; 27:716-722. [PMID: 31883169 PMCID: PMC7155011 DOI: 10.1111/ene.14148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/22/2019] [Indexed: 01/28/2023]
Abstract
Background and purpose Anaemia is associated with poor clinical outcome after ischaemic and haemorrhagic stroke. The association between anaemia and outcome in patients with cerebral venous thrombosis (CVT) was examined. Methods Consecutive adult patients with CVT were included from seven centres. Anaemia at admission was scored according to World Health Organization definitions. Poor clinical outcome was defined as a modified Rankin Scale score 3–6 at last follow‐up. A multiple imputation procedure was applied for handling missing data in the multivariable analysis. Using binary logistic regression analysis, adjustments were made for age, sex, cancer and centre of recruitment (model 1). In a secondary analysis, adjustments were additionally made for coma, intracerebral haemorrhage, non‐haemorrhagic lesion and deep venous system thrombosis (model 2). In a sensitivity analysis, patients with cancer were excluded. Results Data for 952 patients with CVT were included, 22% of whom had anaemia at admission. Patients with anaemia more often had a history of cancer (17% vs. 7%, P < 0.001) than patients without anaemia. Poor clinical outcome (21% vs. 11%, P < 0.001) and mortality (11% vs. 6%, P = 0.07) were more common amongst patients with anaemia. After adjustment, anaemia at admission increased the risk of poor outcome [adjusted odds ratio (aOR) 2.4, 95% confidence interval (CI) 1.5–3.7, model 1]. Model 2 revealed comparable results (aOR 1.9, 95% CI 1.2–3.2), as did the sensitivity analysis excluding patients with cancer (aOR 2.3, 95% CI 1.3–3.8, model 1). Conclusion The risk of poor clinical outcome is doubled in CVT patients presenting with anaemia at admission.
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Affiliation(s)
- S M Silvis
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E Reinstra
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - M Ghiasian
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - K Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S M Zuurbier
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A E Groot
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M A Barboza
- Neurosciences Department, Hospital Dr R.A. Calderón Guardia, CCSS, San José, Costa Rica
| | - A Arauz
- National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - J Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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22
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Liu H, Zheng H, Wu P, Liu CF, Wang D, Li H, Meng X, Wang Y, Cao Y, Wang Y, Pan Y. Estimated glomerular filtration rate, anemia and outcomes in patients with ischemic stroke. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:2. [PMID: 32055593 DOI: 10.21037/atm.2019.11.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Anemia is highly prevalent in patients with low estimated glomerular filtration rate (eGFR). However, the combined effect of anemia and low eGFR on the prognosis of stroke has not been well studied. Methods Data of patients with acute ischemic stroke in the prospective cohort study of China National Stroke Registry was reviewed. According to the levels of eGFR and hemoglobin, patients were categorized into four groups: low eGFR (<60 mL/min per 1.73 m2) or normal eGFR (≥60 mL/min per 1.73 m2) with or without anemia. Multivariate logistic regression methods were used to analyze the association between eGFR with or without anemia and outcomes after stroke [the poor functional outcome (modified Rankin Scale, mRS 3-6), mortality and stroke recurrence] at 3 months and 1 year. Results This study included 8,303 stroke patients. After adjusting for the confounding factors, low eGFR with normal hemoglobin increased the risk of mortality at 1 year of follow-up [odds ratio (OR) =1.50; 95% confidence interval (95% CI), 1.14-1.97]. Anemia with normal eGFR was not associated with any poor outcome at 1-year of follow-up. In patients with both low eGFR and anemia, there was an increased risk of 1-year poor functional outcome (OR 1.73; 95% CI, 1.30-2.29), mortality (OR 2.64; 95% CI, 1.94-3.59) and stroke recurrence (OR 1.42; 95% CI, 1.06-1.91). Combined and interactive effects of the pattern of low eGFR and anemia on the poor functional outcome (P for interaction =0.02) and all-cause mortality (P for interaction =0.046) were observed. Conclusions Ischemic stroke patients with concurrent low eGFR and anemia increased risks of poor functional outcome, mortality and stroke recurrence after 1-year follow-up.
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Affiliation(s)
- Huihui Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Peng Wu
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - David Wang
- Barrow Neurological Institute Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
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