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Jhang SW, Liu YT, Kor CT, Wu YP, Lai CH. Low Prognostic Nutritional Index Predicts In-Hospital Complications and Case Fatality in Patients with Spontaneous Intracerebral Hemorrhage: A Retrospective Study. Nutrients 2024; 16:1841. [PMID: 38931196 PMCID: PMC11206377 DOI: 10.3390/nu16121841] [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: 04/11/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is associated with high case fatality and significant healthcare costs. Recent studies emphasize the critical role of nutritional status in affecting outcomes in neurological disorders. This study investigates the relationship between the Prognostic Nutrition Index (PNI) and in-hospital complications and case fatality among patients with ICH. METHODS A retrospective analysis was performed using data from the Changhua Christian Hospital Clinical Research Database between January 2015 and December 2022. Patients under 20 or over 100 years of age or with incomplete medical data were excluded. We utilized restricted cubic spline models, Kaplan-Meier survival analysis, and ROC analysis to assess the association between PNI and clinical outcomes. Propensity score matching analysis was performed to balance these clinical variables between groups. RESULTS In this study, 2402 patients with spontaneous ICH were assessed using the median PNI value of 42.77. The cohort was evenly divided between low and high PNI groups, predominantly male (59.1%), with an average age of 64 years. Patients with lower PNI scores at admission had higher in-hospital complications and increased 28- and 90-day case fatality rates. CONCLUSIONS Our study suggests that PNI could serve as a valuable marker for predicting medical complications and case fatality in patients with spontaneous ICH.
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Affiliation(s)
- Shang-Wun Jhang
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Department of Neurosurgery, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Yen-Tze Liu
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan;
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Yi-Ping Wu
- Department of Neurosurgery, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Cheng-Hung Lai
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung 402, 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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Liu L, Dong X, Liu Y, Wang S, Wei L, Duan L, Zhang Q, Zhang K. Predictive value of white blood cell to hemoglobin ratio for 30-day mortality in patients with severe intracerebral hemorrhage. Front Neurol 2024; 14:1222717. [PMID: 38283683 PMCID: PMC10811233 DOI: 10.3389/fneur.2023.1222717] [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: 05/15/2023] [Accepted: 08/10/2023] [Indexed: 01/30/2024] Open
Abstract
Aim To explore the predictive value of white blood cell to hemoglobin ratio (WHR) for 30-day mortality in patients with intracerebral hemorrhage (ICH). Methods In this cohort study, 2,848 patients with ICH were identified in the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV. Least absolute shrinkage and selection operator (LASSO) regression screened covariates of 30-day mortality of ICH patients. COX regression analysis was used to study the association of different levels of WHR, white blood cell (WBC), and hemoglobin (Hb) with 30-day mortality. The median follow-up time was 30 (20.28, 30.00) days. Results In total, 2,068 participants survived at the end of the follow-up. WHR was negatively correlated with the Glasgow Coma Score (GCS) (spearman correlation coefficient = -0.143, p < 0.001), and positively associated with the Sepsis-related Organ Failure Assessment (SOFA) score (spearman correlation coefficient = 0.156, p < 0.001), quick SOFA (qSOFA) score (spearman correlation coefficient = 0.156, p < 0.001), and Simplified Acute Physiology Score II (SAPS-II) (spearman correlation coefficient = 0.213, p < 0.001). After adjusting for confounders, WHR >0.833 (HR = 1.64, 95%CI: 1.39-1.92) and WBC >10.9 K/uL (HR = 1.49, 95%CI: 1.28-1.73) were associated with increased risk of 30-day mortality of patients with ICH. The area under the curve (AUC) value of the prediction model based on WHR and other predictors was 0.78 (95%CI: 0.77-0.79), which was higher than SAPSII (AUC = 0.75, 95%CI: 0.74-0.76), SOFA score (AUC = 0.69, 95%CI: 0.68-0.70) and GCS (AUC = 0.59, 95%CI: 0.57-0.60). Conclusion The level of WHR was associated with 30-day mortality in patients with severe ICH, and the WHR-based prediction model might provide a tool to quickly predict 30-day mortality in patients with ICH.
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Affiliation(s)
| | | | | | | | | | | | | | - Kun Zhang
- Department of Neurosurgery, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
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Tian Y, Zhang Y, He J, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Association of anemia with mortality in young adult patients with intracerebral hemorrhage. Sci Rep 2023; 13:19711. [PMID: 37953289 PMCID: PMC10641070 DOI: 10.1038/s41598-023-46941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
This study aimed to examine the association of hemoglobin concentration with a 90-day mortality of young adult patients with ICH in a large retrospective cohort. A retrospective observational study was conducted between December 2013 and June 2019 in two tertiary academic medical centers in China. We defined patients with hemoglobin concentration < 80 g/L as severe anemia and 80-120/130 g/L as mild to moderate anemia. We also defined patients with hemoglobin concentration > 160 g/L as high hemoglobin. Associations of hemoglobin and outcomes were evaluated in multivariable regression analyses. The primary outcome was mortality at 90 days. We identified 4098 patients with ICH who met the inclusion criteria. After adjusting primary confounding variables, the 90-day mortality rate was significantly higher in young patients with severe anemia (OR, 39.65; 95% CI 15.42-101.97), moderate anemia (OR, 2.49; 95% CI 1.24-5.00), mild anemia (OR, 1.89; 95% CI 1.20-2.98), and high hemoglobin (OR, 2.03; 95% CI 1.26-3.26) group than in young patients of the normal group. The younger age was associated with a higher risk of death from anemia in patients with ICH (P for interaction = 0.01). In young adult patients with ICH, hemoglobin concentration was associated with 90-day mortality, and even mild to moderate anemia correlated with higher mortality. We also found that in ICH patients with anemia, younger age was associated with higher risk.
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Affiliation(s)
- Yixin Tian
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pengfei Hao
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Tiangui Li
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Liyuan Peng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yuning Feng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Haidong Deng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Weelic Chong
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chao You
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Fang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Tseng YT, Han DS, Lai JCY, Wang CH, Wang TG, Chen HH. The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study. Arch Phys Med Rehabil 2023; 104:1638-1645. [PMID: 37286069 DOI: 10.1016/j.apmr.2023.05.005] [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: 07/29/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to examine the mediating effect of swallowing ability on hemoglobin levels and activities of daily living (ADL). DESIGN Prospective longitudinal study. SETTING Two rehabilitation wards in a national referral center for Northern Taiwan, followed by discharge. PARTICIPANTS 101 participants were admitted for first or recurrent infarction or hemorrhagic stroke and transferred to the rehabilitation ward of a medical center (N=101). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Hemoglobin data were collected from medical records. Swallowing ability and ADL were measured using the Functional Oral Intake Scale and Barthel Index, respectively, with higher scores indicating better functioning. RESULTS Mediation analysis performed using path analysis illustrated that hemoglobin at the time of transfer to the rehabilitation ward had a direct and positive effect on swallowing ability at 1-3 days before discharge (path coefficient=0.21, 95% confidence interval [CI]: 0.04-0.35, P=.018), and swallowing ability at 1-3 days before discharge had a direct and positive effect on ADL at 1 month after discharge (path coefficient=0.36, 95% CI: 0.13-0.57, P=.002). Hemoglobin level at the time of transfer to the rehabilitation ward did not directly influence ADL 1 month after discharge (path coefficient=0.12, 95% CI: -0.05-0.28, P=.166). These results indicate that swallowing ability substantially mediates the relation between previous hemoglobin levels and subsequent ADL. CONCLUSION Low hemoglobin levels and poor swallowing ability should be concurrently addressed to improve ADL performance.
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Affiliation(s)
- Ying-Tzu Tseng
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, Taipei City, Taiwan; Department of Physical Medicine and rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jerry Cheng-Yen Lai
- Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung City, Taiwan; College of Science and Engineering, National Taitung University, Taitung City, Taiwan
| | - Chien-Hui Wang
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hung-Hui Chen
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan; School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan.
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Li F, Chen A, Li Z, Gu L, Pan Q, Wang P, Fan Y, Feng J. Machine learning-based prediction of cerebral hemorrhage in patients with hemodialysis: A multicenter, retrospective study. Front Neurol 2023; 14:1139096. [PMID: 37077571 PMCID: PMC10109449 DOI: 10.3389/fneur.2023.1139096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/08/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundIntracerebral hemorrhage (ICH) is one of the most serious complications in patients with chronic kidney disease undergoing long-term hemodialysis. It has high mortality and disability rates and imposes a serious economic burden on the patient's family and society. An early prediction of ICH is essential for timely intervention and improving prognosis. This study aims to build an interpretable machine learning-based model to predict the risk of ICH in patients undergoing hemodialysis.MethodsThe clinical data of 393 patients with end-stage kidney disease undergoing hemodialysis at three different centers between August 2014 and August 2022 were retrospectively analyzed. A total of 70% of the samples were randomly selected as the training set, and the remaining 30% were used as the validation set. Five machine learning (ML) algorithms, namely, support vector machine (SVM), extreme gradient boosting (XGB), complement Naïve Bayes (CNB), K-nearest neighbor (KNN), and logistic regression (LR), were used to develop a model to predict the risk of ICH in patients with uremia undergoing long-term hemodialysis. In addition, the area under the curve (AUC) values were evaluated to compare the performance of each algorithmic model. Global and individual interpretive analyses of the model were performed using importance ranking and Shapley additive explanations (SHAP) in the training set.ResultsA total of 73 patients undergoing hemodialysis developed spontaneous ICH among the 393 patients included in the study. The AUC of SVM, CNB, KNN, LR, and XGB models in the validation dataset were 0.725 (95% CI: 0.610 ~ 0.841), 0.797 (95% CI: 0.690 ~ 0.905), 0.675 (95% CI: 0.560 ~ 0.789), 0.922 (95% CI: 0.862 ~ 0.981), and 0.979 (95% CI: 0.953 ~ 1.000), respectively. Therefore, the XGBoost model had the best performance among the five algorithms. SHAP analysis revealed that the levels of LDL, HDL, CRP, and HGB and pre-hemodialysis blood pressure were the most important factors.ConclusionThe XGB model developed in this study can efficiently predict the risk of a cerebral hemorrhage in patients with uremia undergoing long-term hemodialysis and can help clinicians to make more individualized and rational clinical decisions. ICH events in patients undergoing maintenance hemodialysis (MHD) are associated with serum LDL, HDL, CRP, HGB, and pre-hemodialysis SBP levels.
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Affiliation(s)
- Fengda Li
- Department of Neurosurgery, Changshu Hospital Affiliated to Soochow University, Changshu, China
| | - Anmin Chen
- Department of Nephrology, The First People's Hospital of Jintan, Changzhou, China
| | - Zeyi Li
- School of Computer Science, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Longyuan Gu
- Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qiyang Pan
- Faculty of Informatics, Università della Svizzera italiana, Lugano, Ticino, Switzerland
| | - Pan Wang
- School of Computer Science, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Yuechao Fan
- Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- *Correspondence: Yuechao Fan
| | - Jinhong Feng
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Jinhong Feng
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Yang Y, Huang S, Jia Y, Song G, Ye X, Lu K, Li G, Wang F, Zhu S. A 6-month prognostic nomogram incorporating hemoglobin level for intracerebral hemorrhage in younger adults. BMC Neurol 2023; 23:6. [PMID: 36609246 PMCID: PMC9817395 DOI: 10.1186/s12883-022-03039-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Intracerebral hemorrhage (ICH) is the second most common subtype of stroke, with high mortality and morbidity. At present, there are no effective 6-month prognostic markers, particularly for younger patients. The aim of this research was to construct a new valuable prognostic nomogram model incorporating haemoglobin levels for adult patients with ICH. METHODS Patients aged between 18 and 50 presenting with intracerebral haemorrhage at the Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between January 1st 2012 and December 31st 2018 were included in this retrospective study. Independent factors of prognosis were identified by univariate and multivariate logistic regression analyses, and a new nomogram model was constructed and validated. The clinical value of the nomogram model was subsequently explored utilizing decision curve analysis and clinical impact curves. RESULTS In total, 565 patients were enrolled in this study, 117 (20.7%) of whom developed an unfavourable prognosis. Infratentorial lesion (adjusted odds ratio [aOR] = 3.708, 95% confidence interval [CI], 1.490-9.227; P = 0.005) was the most significant unfavourable outcome. Age ([aOR] = 1.054; 95% CI, 1.014-1.096; P = 0.008), hematoma volume (aOR = 1.014, 95% CI, 1.002-1.027; P = 0.024), haemoglobin (aOR = 0.981, 95% CI, 0.969-0.993; P = 0.002), blood glucose (aOR = 1.135, 95% CI, 1.037-1.241; P = 0.005) and NIHSS (aOR = 1.105, 95% CI, 1.069-1.141; P < 0.001) were independent risk factors. Based on these 6 factors, the nomogram can be employed to predict early functional prognosis with high accuracy (AUC 0.791). Decision curve analysis and clinical impact curves showed an increased net benefit for utilizing the nomogram. CONCLUSION The haemoglobin level at admission may be an easily overlooked factor in clinical work. This new nomogram model could be a promising and convenient tool to predict the early functional prognosis of adults with ICH. More prospective multicentre studies are needed to validate these findings.
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Affiliation(s)
- Yuyan Yang
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Shanshan Huang
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Yuchao Jia
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Guini Song
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Xiaodong Ye
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Kai Lu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Guo Li
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Furong Wang
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Suiqiang Zhu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
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Zhang L, Yin J, Sun H, Li J, Zhao X, Liu Y, Yang J. Relationship between mean corpuscular volume and 30-day mortality in patients with intracerebral hemorrhage: Evidence from the MIMIC-III database. Medicine (Baltimore) 2022; 101:e31415. [PMID: 36343042 PMCID: PMC9646635 DOI: 10.1097/md.0000000000031415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Previous studies have shown that mean corpuscular volume (MCV) levels are associated with the prognosis of patients with cardiovascular disease. However, the relationship between MCV levels and mortality in patients with intracerebral hemorrhage (ICH) remains unclear. Patients with ICH were extracted from the Medical Information Mart for Intensive Care-III database. The primary outcome measure was 30-day mortality. Multivariate Cox regression analysis was used to investigate the relationship between MCV at admission and 30-day mortality in ICH patients. We enrolled 1100 patients with ICH. After adjustment for potential confounders, we found that a 1 unit increase in MCV (fl) was associated with a 3% increase in 30-day mortality (HR = 1.03, 95% CI = 1.01-1.05, P = .0015). High MCV (MCV ≥ 92 fl) compared with the low MCV group (MCV < 87 fl) showed a 46% increase of 30-day mortality (HR = 1.46, 95% CI = 1.10-1.92 P = .008). In subgroups analysis's the results remained stable. We demonstrated that MCV at admission was positively associated with 30-day mortality. The Kaplan-Meier (KM) method was used to plot survival curves of three groups with different admission MCV levels.
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Affiliation(s)
- Lu Zhang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiahui Yin
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Haiyang Sun
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinling Li
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xuelian Zhao
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuanxiang Liu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- * Correspondence: Yuanxiang Liu, Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369 Jingshi Road, Lixia District, Jinan City 250014, Shandong Province, China (e-mail: )
| | - Jiguo Yang
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, China
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Zhang S, Shu Y, Chen Y, Liu X, Liu Y, Cheng Y, Wu B, Lei P, Liu M. Low hemoglobin is associated with worse outcomes via larger hematoma volume in intracerebral hemorrhage due to systemic disease. MedComm (Beijing) 2022; 3:e96. [PMID: 35281786 PMCID: PMC8906467 DOI: 10.1002/mco2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 02/05/2023] Open
Abstract
Whether hemoglobin is associated with outcomes of a specific subtype of intracerebral hemorrhage (ICH) is unknown. A total of 4643 patients with ICH from a multicenter cohort were included in the analysis (64.0% male; mean age [SD], 58.3 [15.2] year), of whom 1319 (28.4%) had anemia on admission. The unsupervised consensus cluster method was employed to classify the patients into three clusters. The patients of cluster 3 were characterized by a high frequency of anemia (85.3%) and mainly composed of patients of systemic disease ICH subtype (SD-ICH; 90.0%) according to the SMASH-U etiologies. In SD-ICH, a strong interaction effect was observed between anemia and 3-month death (adjusted odds ratio [aOR] 4.33, 95% confidence interval [CI] 1.60-11.9, p = 0.004), and the hemoglobin levels were linearly associated with 3-month death (aOR 0.75, 95% CI 0.60-0.92; p = 0.009), which was partially mediated by larger baseline hematoma volume (p = 0.008). This study demonstrated a strong linear association between low hemoglobin levels and worse outcomes in SD-ICH, suggesting that hemoglobin-elevating therapy might be extensively needed in a specific subtype of ICH.
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Affiliation(s)
- Shuting Zhang
- Department of Neurology, West China HospitalSichuan UniversityChengduP. R. China
| | - Yang Shu
- State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduP. R. China
| | - Yunlong Chen
- West China School of MedicineSichuan UniversityChengduP. R. China
| | - Xiaoyang Liu
- West China School of MedicineSichuan UniversityChengduP. R. China
| | - Yu Liu
- State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduP. R. China
| | - Yajun Cheng
- Department of Neurology, West China HospitalSichuan UniversityChengduP. R. China
| | - Bo Wu
- Department of Neurology, West China HospitalSichuan UniversityChengduP. R. China
| | - Peng Lei
- Department of Neurology, West China HospitalSichuan UniversityChengduP. R. China
- State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduP. R. China
| | - Ming Liu
- Department of Neurology, West China HospitalSichuan UniversityChengduP. R. China
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Mureșan EM, Golea A, Vesa Ș, Lenghel M, Csutak C, Perju‑Dumbravă L. Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study. Exp Ther Med 2022; 23:200. [PMID: 35126703 PMCID: PMC8794556 DOI: 10.3892/etm.2022.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (sICH) results in high morbidity and mortality rates, thus identifying strategies for timely prognosis and treatment is important. The present study aimed to analyze the relationship between emergency department point-of-care (POC) blood biomarkers and day 90 functional outcome (FO) in patients with acute (<8 h) sICH. On-site POC determinations, including complete blood count, glucose, cardiac troponin I, D-dimer and C-reactive protein, and derived inflammatory indexes were performed for a cohort of 35 patients. The primary endpoint was a favorable day 90 FO (modified Rankin Score ≤3). Secondary endpoints included early neurological worsening (ENW), day 7/discharge neurological impairment, day 90 independence assessment (Barthel Index <60), hematoma enlargement and perihematomal edema (PHE) growth. A favorable three-month FO was reported in 16 (46%) participants. Older age, previous history of ischemic stroke and initial imagistic parameters, including intraventricular hemorrhage, enlarged contralateral ventricle and cerebral atrophy, significantly predicted an unfavorable FO. The admission D-dimer similarly predicted day 90 FO and the independence status, along with ENW and a more severe day 7/discharge neurological status. The D-dimer also correlated with the initial neurological status and PHE. PHE growth correlated with granulocytes, systemic immune-inflammation index and glycemia. The results suggested that a lower admission D-dimer could indicate an improved day 90 FO of patients with sICH, while also anticipating the development of PHE growth and ENW.
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Affiliation(s)
- Eugenia-Maria Mureșan
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Discipline, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400006 Cluj‑Napoca, Romania
| | - Ștefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400349 Cluj‑Napoca, Romania
| | - Manuela Lenghel
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Csaba Csutak
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Lăcrămioara Perju‑Dumbravă
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
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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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Kim YS, Jeong HG, Chae HY, Kim BJ, Kang J, Kim JY, Kim T, Bang JS, Bae HJ, Oh CW, Han MK. Mediation effects of mean Hounsfield unit on relationship between hemoglobin and expansion of intracerebral hemorrhage. Sci Rep 2021; 11:17236. [PMID: 34446807 PMCID: PMC8390671 DOI: 10.1038/s41598-021-96790-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022] Open
Abstract
Low hemoglobin levels are known to be associated with hematoma expansion (HE) and poor functional outcome in patients with intracerebral hemorrhage (ICH). However, it is not yet known whether low hemoglobin itself causes HE directly or is merely a confounder. Thus, we investigated the mediation effect of the mean Hounsfield unit (HU) of hematoma on the relationship between low hemoglobin and expansion of ICH. Overall, 232 consecutive patients with ICH who underwent non-contrast computed tomography (NCCT) within 12 h since onset were included. The mean HU and hematoma volume on NCCT were investigated using semi-automated planimetry. HE was defined as an increase in hematoma volume > 33% or 6 mL. The respective associations among the hemoglobin level, mean HU, and HE were analyzed using multivariable regression analysis, adjusting for age, sex, and known HE predictors. Mediation analysis was performed to examine the potential causal association among the three. HE occurred in 34.5% of patients; hemoglobin levels were inversely associated with HE occurrence (adjusted odds ratio, 0.90; p = 0.03). The mean HU of the hematoma was lower in patients with HE than in patients without HE (58.5 ± 3.3 vs. 56.8 ± 3.0; p < 0.01). Hemoglobin levels on admission were linearly related to the mean HU (adjusted β, 0.33; p < 0.01) after adjusting for known HE predictors (time from onset to CT, antithrombotic use, hematoma volume). Causal mediation analysis showed a significant mediation effect of the mean HU on the association between hemoglobin levels and HE (p = 0.04). The proportion of indirect effect through the mean HU among the total effect was 19% (p = 0.05). The mediation effect became nonsignificant in the when the multivariable model was adjusted with additional covariates (baseline systolic blood pressure and hematoma location). The mean HU of the hematoma mediated the association between hemoglobin levels and HE occurrence. Therefore, the mean HU of the hematoma may be a potential marker of impaired hemostasis in patients with ICH.
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Affiliation(s)
- Yong Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Han-Gil Jeong
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. .,Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Hee-Yun Chae
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea.,Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
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13
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Lu Y, Jin H, Zhao Y, Li Y, Xu J, Tian J, Luan X, Chen S, Sun W, Zhang S, Xu S, Zhu F, Chen L, Mima D, Sun Y, Zhuoga C. Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2021; 36:395-403. [PMID: 34313936 PMCID: PMC8964592 DOI: 10.1007/s12028-021-01305-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
Background Studies of the impact of increased hemoglobin on spontaneous intracerebral hemorrhage (ICH) are limited. The present study aimed to explore the effect of increased hemoglobin on ICH. Methods A retrospective single-center study using medical records from a database processed by univariate and multivariate analyses was performed in the People’s Hospital of Tibet Autonomous Region in Lhasa, Tibet, China. Results The mean hemoglobin level in 211 patients with ICH was 165.03 ± 34.12 g/l, and a median hematoma volume was 18.5 ml. Eighty-eight (41.7%) patients had large hematomas (supratentorial hematoma ≥ 30 ml; infratentorial hematoma ≥ 10 ml). No differences in ICH risk factors between the groups with different hemoglobin levels were detected. Increased hemoglobin was independently associated with large hematomas [odds ratio (OR) 1.013, P = 0.023]. Increased hemoglobin was independently associated with ICH with subarachnoid hemorrhage (OR 1.014, P = 0.016), which was more pronounced in men (OR 1.027, P = 0.002). Increased hemoglobin was independently associated with basal ganglia hemorrhage and lobar hemorrhage in men (OR 0.986, P = 0.022; OR 1.013, P = 0.044, respectively) but not in women (P > 0.1). Conclusions Increased hemoglobin was independently associated with large hemorrhage volume. Increased hemoglobin was independently associated with lobar hemorrhage in men and ICH with subarachnoid hemorrhage, which was more pronounced in men. Additional studies are needed to confirm our findings and explore potential mechanisms.
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Affiliation(s)
- Yuxuan Lu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Yuxian Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jun Xu
- Department of Cognitive Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiayu Tian
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xiaoting Luan
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Siwei Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Shouzi Zhang
- Department of Psychiatry, Beijing Geriatric Hospital, Beijing, China
| | - Shunliang Xu
- Department of Neurology, the Second Hospital, Shandong University, Jinan, Shandong Province, China
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology Department, the Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Dunzhu Mima
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China.
| | - Cidan Zhuoga
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China.
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Yoshimura Y, Wakabayashi H, Shiraishi A, Nagano F, Bise T, Shimazu S. Hemoglobin Improvement is Positively Associated with Functional Outcomes in Stroke Patients with Anemia. J Stroke Cerebrovasc Dis 2020; 30:105453. [PMID: 33188950 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/16/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke. METHODS This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders. RESULTS Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (β = 0.114, p = 0.031), and negatively associated with length of stay (β = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (β = 0.267, p = 0.001). CONCLUSIONS A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan.
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan.
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15
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Yoshimura Y, Wakabayashi H, Nagano F, Bise T, Shimazu S, Shiraishi A. Low Hemoglobin Levels are Associated with Sarcopenia, Dysphagia, and Adverse Rehabilitation Outcomes After Stroke. J Stroke Cerebrovasc Dis 2020; 29:105405. [PMID: 33254381 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105405] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of our study was to evaluate the associations between baseline hemoglobin (Hb) levels and sarcopenia and outcomes in patients undergoing rehabilitation after stroke. METHODS This retrospective cohort study included consecutive hospitalized post-stroke patients. Data on serum Hb level were extracted from medical records on tests performed within 24 h of admission. Primary outcome was the presence of sarcopenia at admission, diagnosed based on both low skeletal muscle mass and strength criteria per recently updated Asian Working Group for Sarcopenia 2019 guidelines. Other outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and its change from baseline, and the Food Intake Level Scale (FILS) score (measure of dysphagia, FILS score < 7) at discharge. Multivariate analyses were used to determine the association between Hb levels at admission and outcomes of interest, adjusted for potential confounders. RESULTS Data from 598 patients (mean age 72.1 years; 52.7% men) were included in the analysis. The mean Hb level at admission was 13.2 g/dL, and 86 (27.3%) men and 102 (36.0%) women had low Hb levels, i.e., 13.0 g/dL and 12.0 g/dL, respectively. In multivariate analyses, the baseline Hb level was independently associated with sarcopenia (odds ratio [OR]: 0.794, 95% confidence interval [CI]: 0.677-0.930, p = 0.004), FIM-motor score (β = 0.096, p = 0.045) at discharge and its change from baseline (β = 0.191, p = 0.018), and dysphagia (OR: 0.762, 95% CI: 0.595-0.961, p = 0.041) at discharge. CONCLUSION Baseline low Hb levels were associated with sarcopenia, poorer recovery of physical function, and dysphagia in patients undergoing rehabilitation after stroke.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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16
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Yu Z, Zheng J, You C. Reader response: Low hemoglobin and hematoma expansion after intracerebral hemorrhage. Neurology 2020; 94:1051. [DOI: 10.1212/wnl.0000000000009607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Gong L, Gu Y, Yu Q, Wang H, Zhu X, Dong Q, Xu R, Zhao Y, Liu X. Prognostic Factors for Cognitive Recovery Beyond Early Poststroke Cognitive Impairment (PSCI): A Prospective Cohort Study of Spontaneous Intracerebral Hemorrhage. Front Neurol 2020; 11:278. [PMID: 32411073 PMCID: PMC7198781 DOI: 10.3389/fneur.2020.00278] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Poststroke cognitive impairment (PSCI) has been increasingly recognized in patients, but some stroke survivors appear to show cognitive improvement beyond the acute stage. The risk factors associated with cognitive recovery after spontaneous intracerebral hemorrhage (ICH) onset have not yet been sufficiently investigated in prospective studies. Objective: We aimed to identify the trajectory of post-ICH cognitive impairment and the association of potential prognostic factors with follow-up cognitive recovery beyond early PSCI. Methods: In this stroke center-based cohort study, 141 consecutive dementia-free patients with spontaneous ICH were included and underwent Montreal Cognitive Assessment (MoCA) evaluation for cognitive function at baseline (within 2 weeks of ICH onset) and the shortened MoCA (short-MoCA) at a 6-month follow-up. To explore the prognostic factors associated with trajectory of cognition after an ICH onset, we adjusted for demographic and vascular risk factors, using multivariate logistic regression analysis. Results: Of the 141 ICH patients, approximately three quarters (106/141) were diagnosed with early PSCI (MoCA score <26) within 2 weeks of ICH onset. The multiple logistic regression indicated independent positive associations between risk of early PSCI and dominant-hemisphere hemorrhage [odd's ratio (OR): 8.845 (3.347–23.371); P < 0.001], mean corpuscular volume (MCV) [OR: 1.079 (1.002–1.162); P = 0.043], admission systolic blood pressure (sBP) [OR: 1.021 (1.005–1.038); P = 0.012]. Furthermore, 36% (33/90) of ICH survivors who had early PSCI exhibited cognitive recovery at the 6-month follow-up. After examining potential predictors through multiple linear regression based on stepwise, there were independent negative associations between cognitive recovery and dominant hemisphere hemorrhage [OR: 6.955 (1.604–30.162); P < 0.01], lobar ICH [OR: 8.363 (1.479–47.290); P = 0.016], years of education ≤ 9 [OR: 5.145 (1.254–21.105); P = 0.023], and MCV [OR: 1.660 (1.171–2.354); P = 0.004]. Baseline cognitive performance in the domains of visuospatial/executive function, attention, orientation, and language showed positive correlations with cognitive improvement (P < 0.05). Conclusion: In this cohort study of dementia-free survivors of ICH, our results show that one in three early PSCI survivors exhibit cognitive recovery, in relation to dominant-hemisphere hematoma, lobar ICH, educational history, and MCV levels. Future clinical trials including ICH survivors with cognitive dysfunction should assess these factors.
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Affiliation(s)
- Li Gong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yongzhe Gu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qiuyue Yu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Haichao Wang
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaoping Zhu
- School of Nursing, Second Military Medical University, Shanghai, China.,Department of Nursing, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Rong Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
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