Development and validation of a prognostic prediction model for antithrombotic-related chronic subdural hematoma in patients with recent acute myocardial infarction

Frailty as a predictor of poor outcomes in patients with chronic subdural hematoma (cSDH): A systematic review of literature

Objective

In recent years, frailty has been reported to be an important predictive factor associated with worse outcomes in neurosurgical patients. The purpose of the present systematic review was to analyze the impact of frailty on outcomes of chronic subdural hematoma (cSDH) patients.

Methods

We performed a systematic review of literature using the PubMed, Cochrane library, Wiley online library, and Web of Science databases following PRISMA guidelines of studies evaluating the effect of frailty on outcomes of cSDH published until January 31, 2023.

Results

A comprehensive literature search of databases yielded a total of 471 studies. Six studies with 4085 patients were included in our final qualitative systematic review. We found that frailty was associated with inferior outcomes (including mortality, complications, recurrence, and discharge disposition) in cSDH patients. Despite varying frailty scales/indices used across studies, negative outcomes occurred more frequently in patients that were frail than those who were not.

Conclusions

While the small number of available studies, and heterogenous methodology and reporting parameters precluded us from conducting a pooled analysis, the results of the present systematic review identify frailty as a robust predictor of worse outcomes in cSDH patients. Future studies with a larger sample size and consistent frailty scales/indices are warranted to strengthen the available evidence. The results of this work suggest a strong case for using frailty as a pre-operative risk stratification measure in cSDH patients.

Construction of a predictive model for new-onset atrial fibrillation after acute myocardial infarction based on P-wave amplitude in lead V1

BACKGROUND

In this study, we aimed to identify the risk factors for new-onset atrial fibrillation (NOAF) after postcoronary intervention in patients with acute myocardial infarction (AMI) and to establish a nomogram prediction model.

METHODS

The clinical data of 506 patients hospitalized for AMI from March 2020 to February 2023 were retrospectively collected, and the patients were randomized into a training cohort (70%; n = 354) and a validation cohort (30%; n = 152). Independent risk factors were determined using least absolute shrinkage and selection operator and multivariate logistic regression. Predictive nomogram modeling was performed using R software. Nomograms were evaluated based on discrimination, correction, and clinical efficacy using the C-statistic, calibration plot, and decision curve analysis, respectively.

RESULTS

The multivariate logistic regression analysis showed that P-wave amplitude in lead V1, age, and infarct type were independent risk factors for NOAF, and the area under the receiver operating characteristic curve of the training and validation sets was 0.760 (95% confidence interval [CI] 0.674-0.846) and 0.732 (95% CI 0.580-0.883), respectively. The calibration curves showed good agreement between the predicted and observed values in both the training and validation sets, supporting that the actual predictive power was close to the ideal predictive power.

CONCLUSIONS

P-wave amplitude in lead V1, age, and infarct type were independent risk factors for NOAF in patients with AMI after intervention. The nomogram model constructed in this study can be used to assess the risk of NOAF development and has some clinical application value.

Renin-angiotensin-aldosterone system inhibitors as a risk factor for chronic subdural hematoma recurrence: A matter of debate

OBJECTIVES

Chronic subdural hematoma (cSDH) is a common central nervous system condition. Recent reports indicate that cSDH affects long-term prognosis; however, its definitive risk factors remain unknown. An antihypertensive drug, renin-angiotensin-aldosterone system inhibitors (RAASi), can affect vascular permeability and cell proliferation processes, which may suppress the recurrence of cSDH. However, several studies have reported negative results to this effect. Therefore, we aimed to evaluate antihypertensive drugs, including RAASi, as risk factors for recurrent cSDH.

MATERIALS AND METHODS

A total of 203 consecutive cases of surgically treated cSDH were retrospectively reviewed. Clinical and radiological parameters were compared between the groups with and without cSDH recurrence to identify risk factors.

RESULTS

Of the included cases, 68 (33.5%) used RAASi and 37 (18.2%) developed recurrence within 60 days of surgery. In the multiple logistic regression analysis adjusted by composite risk score, the odds ratios (95% confidence interval) of RAASi, calcium channel blockers, diuretics, β and α blockers, for the recurrent risk of cSDH after surgery were 2.49 (1.16, 5.42), 1.79 (0.84, 3.82), 1.83 (0.62, 4.87), 0.90 (0.28, 2.44), and 0.96 (0.21, 3.20), respectively. The Cox proportional hazard model also demonstrated that RAASi-use was an independent risk factor for cSDH recurrence.

CONCLUSIONS

Present series suggests RAASi-use as a risk factor for cSDH recurrence, although the role of RAASi-use in cSDH remains debatable. Further studies for deeper understanding of the microenvironment of hematoma and the surroundings are preferable. (235 words).

Associations of serum expressions of miR-499 and sex determining region Y-box 6 with prognosis of acute myocardial infarction patients

Background: To explore the associations of serum expressions of miR-499 and sex determining region Y-box 6 (SOX6) with major adverse cardiovascular and cerebrovascular events (MACCE) and prognosis of acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).

Methods: The clinical data of 132 patients diagnosed from February 2016 to October 2019 were collected. Serum miR-499 and SOX6 expressions were detected by RT-qPCR. Optimal cut-off values were determined using receiver operating characteristic curves, based on which patients were divided into low and high miR-499 expression groups, and high and low SOX6 expression groups. Survival curves were plotted using Kaplan-Meier method, and the independent risk factors for MACCE were explored by multivariate logistic regression analysis. A nomogram model was established based on the factors and validated using internal data.

Results: AMI group had higher miR-499 expression and lower SOX6 expression than those of control group (P<0.05). After PCI, miR-499 expression decreased and SOX6 expression increased (P<0.05). Low miR-499 expression group had higher 3-year survival and MACCE-free rates than those of high miR-499 expression group (P<0.05). Low SOX6 expression group had lower 3-year survival and MACCE-free rates than those of high SOX6 expression group (P<0.05). AMI history, LVEF, CK-MB, miR-499 and SOX6 expressions were independent risk factors for MACCE (P<0.05). The nomogram model had high accuracy for predicting overall survival, with a concordance index of 0.742 (95%CI=0.684-0.845).

Conclusions: AMI patients have increased serum expression of miR-499 and decreased expression of SOX6. High miR-499 expression is an independent risk factor for poor prognosis. The established nomogram model can be used to predict the risk of MACCE after PCI.