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Wang J, Feng Q, Zhang Y, Qiu W, Gao H. Elevated Glucose-Potassium Ratio Predicts Preoperative Rebleeding in Patients With Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2022; 12:795376. [PMID: 35095738 PMCID: PMC8793357 DOI: 10.3389/fneur.2021.795376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Recent reports revealed that higher serum glucose-potassium ratio (GPR) levels at admission were significantly associated with poor outcomes at 3 months following aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to investigate the association between GPR and the risk of rebleeding following aSAH. Methods: This single-center retrospective study of patients with aSAH was conducted in our hospital between January 2008 and December 2020. Patients meeting the inclusion criteria were divided into the rebleed group and the non-rebleed group. Univariate and multivariate analyses were implemented to assess the association between risk factors of rebleeding and outcomes. Results: A total of 1,367 patients experiencing aSAH, 744 patients who met the entry criteria in the study [mean age (54.89 ± 11.30) years; 60.50% female patients], of whom 45 (6.05%) developed rebleeding. The patients in the rebleed group had significantly higher GPR levels than those of patients without rebleeding [2.13 (1.56-3.20) vs. 1.49 (1.23-1.87); p < 0.001]. Multivariable analysis revealed that higher mFisher grade and GPR were associated with rebleeding [mFisher grade, odds ratios (OR) 0.361, 95% CI 0.166-0.783, p = 0.01; GPR, OR 0.254, 95% CI 0.13-0.495, p < 0.001]. The receiver operating characteristics (ROCs) analysis described that the suitable cut-off value for GPR as a predictor for rebleeding in patients with aSAH was determined as 2.09 (the area under the curve [AUC] was 0.729, 95% CI 0.696-0.761, p < 0.0001; the sensitivity was 53.33%, and the specificity was 83.98%). Pearson correlation analysis showed a significant positive correlation between GPR and mFisher grade, between GPR and Hunt-Hess grade (mFisher grade r = 0.4271, OR 0.1824, 95% CI 0.3665-0.4842, p < 0.001; Hunt-Hess grade r = 0.4248, OR 0.1836, 95% CI 0.3697-0.4854, p < 0.001). The patients in the poor outcome had significantly higher GPR levels than those of patients in the good outcome [1.87 (1.53-2.42) vs. 1.45 (1.20-1.80); p < 0.001]. Multivariable analysis demonstrated that GPR was an independent predictor for poor prognosis. The AUC of GPR was 0.709 (95% CI 0.675-0.741; p < 0.0001) (sensitivity = 77.70%; specificity = 55.54%) for poor prognosis. Conclusion: Higher preoperative serum GPR level was associated with Hunt-Hess grade, mFisher grade, rebleeding, and unfunctional outcome, and that they predicted preoperative rebleeding and the 90-days outcome of non-diabetic patients with aSAH, who had potentially relevant clinical implications in patients with aSAH.
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Affiliation(s)
- Jiayin Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Qiangqiang Feng
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Yinbin Zhang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weizhi Qiu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Hongzhi Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
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He Q, Zhou Y, Liu C, Zhang X, Huang N, Wang F, Liu G, Cheng Y, Xie Z. Thromboelastography with Platelet Mapping Detects Platelet Dysfunction in Patients with Aneurysmal Subarachnoid Hemorrhage with Rebleeding. Neuropsychiatr Dis Treat 2019; 15:3443-3451. [PMID: 31908459 PMCID: PMC6924584 DOI: 10.2147/ndt.s229284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) has high rates of disability and mortality, and aneurysm rebleeding is associated with poor functional outcomes. Thrombelastography with platelet mapping (TEG-PM) measures platelet function; however, it has not yet been researched in aSAH. We aimed to use TEG-PM to detect changes in platelet function in patients with aSAH and the difference in patients with and without rebleeding. METHODS We retrospectively included patients with aSAH who underwent a TEG-PM test on admission. Rebleeding was diagnosed according to clinical and imaging data. TEG-PM data of patients with unruptured intracranial aneurysms (UIA) were also obtained as controls. Univariate and multivariate logistic regression models were performed to investigate the relationship between the platelet function and rebleeding. RESULTS A total of 245 aSAH patients and 32 UIA patients were included in our study. Compared with controls, patients with aSAH demonstrated higher arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition of platelet function (P<0.05). Among them, 27 patients with Hunt-Hess grade IV or V were classified as the severe SAH group. There was a significant correlation between the severe SAH group and the degree of pathway inhibition (P<0.05). Furthermore, AA (Spearman's r=0.264, P<0.001) and ADP (Spearman's r=0.183, P=0.004) inhibition were elevated in Hunt-Hess grade-dependent manners. The AA (Spearman's r=0.169, P=0.008) and ADP (Spearman's r=0.233, P<0.001) inhibition were also significantly correlated with Fisher grade. Thirty-five patients (14.3%) suffered rebleeding. Rebleeding was significantly correlated with systolic blood pressure (P=0.011), diastolic blood pressure (P=0.008), Hunt-Hess grade (P=0.034), Fisher grade (P=0.015), AA inhibition (P<0.001), and ADP inhibition (P<0.001). Multivariate logistic regression analysis model revealed that both AA (P=0.037) and ADP inhibition (P=0.008) were independent determinants for rebleeding. CONCLUSION TEG-PM may assess platelet dysfunction in patients with aSAH, and the diminished platelet response to ADP and AA may be associated with rebleeding. These findings deserve further investigation.
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Affiliation(s)
- Qiuguang He
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - You Zhou
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiang Zhang
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ning Huang
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Feng Wang
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Guodong Liu
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Role of Apolipoprotein E Genotypes in Aneurysmal Subarachnoid Hemorrhage: Susceptibility, Complications, and Prognosis. World Neurosurg 2018; 118:e666-e676. [DOI: 10.1016/j.wneu.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 12/20/2022]
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Maserati M, Alexander SA. Genetics and Genomics of Acute Neurologic Disorders. AACN Adv Crit Care 2018; 29:57-75. [PMID: 29496714 DOI: 10.4037/aacnacc2018566] [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: 01/10/2023]
Abstract
Neurologic diseases and injuries are complex and multifactorial, making risk prediction, targeted treatment modalities, and outcome prognostication difficult and elusive. Genetics and genomics have affected clinical practice in many aspects in medicine, particularly cancer treatment. Advancements in knowledge of genetic and genomic variability in neurologic disease and injury are growing rapidly. Although these data are not yet ready for use in clinical practice, research continues to progress and elucidate information that eventually will provide answers to complex neurologic questions and serve as a platform to provide individualized care plans aimed at improving outcomes. This article provides a focused review of relevant literature on genetics, genomics, and common complex neurologic disease and injury likely to be seen in the acute care setting.
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Affiliation(s)
- Megan Maserati
- Megan Maserati is a PhD student at University of Pittsburgh, Pittsburgh, Pennsylvania. Sheila A. Alexander is Associate Professor, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261
| | - Sheila A Alexander
- Megan Maserati is a PhD student at University of Pittsburgh, Pittsburgh, Pennsylvania. Sheila A. Alexander is Associate Professor, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261
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Panenka WJ, Gardner AJ, Dretsch MN, Crynen GC, Crawford FC, Iverson GL. Systematic Review of Genetic Risk Factors for Sustaining a Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:2093-2099. [PMID: 28100103 DOI: 10.1089/neu.2016.4833] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This systematic review examined the association between genetics and risk for sustaining a traumatic brain injury. We retrieved articles published in English from 1980 to July 2016 obtained from the online databases PubMed, PsycINFO®, MEDLINE®, Embase, and Web of Science. In total 5903 articles were identified, 77 underwent full-text screening, and 6 were included in this review. Five studies examined the risk of concussion associated with apolipoprotein E alleles (APOE-ɛ2, ɛ3,ɛ4), and polymorphisms of the APOE promoter (rs405509), brain derived neurotrophic factor (BDNF, rs6265), and dopamine receptor D2 (DRD2, rs1800497) were each considered in two studies. Microtubule associated protein tau (TAU exon 6 polymorphisms His47Tyr [rs2258689] and Ser53Pro [rs10445337]), and neurofilament heavy (NEHF, rs165602) genotypic variants, were the focus of single studies. No study showed an increased risk associated solely with the presence of the APOE-ɛ4 allele, nor were there any significant findings for the NEFH, TAU, or DRD2 genotypic variants. Two studies examined the APOE promoter -219G/T polymorphism in athletes, and both found an association with concussion. Both BDNF studies also found a significant association with concussion incidence; United States soldiers with the Met/Met genotype were more likely to report a history of concussion prior to deployment and to sustain a concussion during deployment. We conclude that the APOE promoter -219G/T polymorphism and the BDNF Met/Met genotype might confer risk for sustaining a TBI. Based on research to date, the APOE-ɛ4 allele does not appear to influence risk. More research is needed to determine if these findings replicate.
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Affiliation(s)
- William J Panenka
- 1 British Columbia Neuropsychiatry Program and Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrew J Gardner
- 2 Hunter New England Local Health District Sports Concussion Program; & Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
| | - Michael N Dretsch
- 3 Human Dimension Division (HDD), Headquarters Army Training and Doctrine Command (HQ TRADOC) , Fort Eustis, Virginia
| | | | | | - Grant L Iverson
- 5 Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 6 Defense and Veterans Brain Injury Center , Bethesda, Maryland
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Dretsch MN, Silverberg N, Gardner AJ, Panenka WJ, Emmerich T, Crynen G, Ait-Ghezala G, Chaytow H, Mathura V, Crawford FC, Iverson GL. Genetics and Other Risk Factors for Past Concussions in Active-Duty Soldiers. J Neurotrauma 2017; 34:869-875. [DOI: 10.1089/neu.2016.4480] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael N. Dretsch
- United States Army Aeromedical Research Laboratory, Fort Rucker, Alabama
- Human Dimension Division (HDD), Headquarters Army Training and Doctrine Command (HQ TRADOC), Fort Eustis, Virginia
| | - Noah Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- Roskamp Institute, Sarasota, Florida
| | - Andrew J. Gardner
- Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital and Home Base, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
- Defense and Veterans Brain Injury Center, Bethesda, Maryland
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Zhao D, Zhang Z, Wu GB, Wang HY, Gao F, Duan XD, Lu YY, Wang ZM, You DP, Qu Y, Song J. Apolipoprotein E gene polymorphism and the risk of subarachnoid hemorrhage: a meta-analysis of case-control studies. Acta Neurochir (Wien) 2016; 158:1515-22. [PMID: 27241684 DOI: 10.1007/s00701-016-2824-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/25/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies investigating the association between the apolipoprotein E gene (APOE) polymorphism and the risk of subarachnoid hemorrhage (SAH) have reported inconsistent results. So we performed a meta-analysis to estimate the association between APOE polymorphism and SAH susceptibility. METHODS Relevant studies published before 5 November 2015 were identified by searching PubMed, Embase, EBSCO, and ISI web of knowledge. The strength of relationship between the APOE gene and SAH susceptibility was assessed using odds ratio (OR) and corresponding 95 % confidence interval (95 % CI). RESULTS A total number of six case-control studies including 638 SAH cases and 2,341 controls were identified. No association was found in dominant model or allele contrast genetic model (ε4 dominant model: OR = 1.06, 95 % CI = 0.91-1.25; ε3 dominant model: OR = 0.99, 95 % CI = 0.97-1.01; ε2 dominant model: OR = 0.99, 95 % CI = 0.78-1.25; ε4 versus ε3: OR = 1.14, 95 % CI = 0.96-1.35; ε4 versus ε2: OR = 1.07, 95 % CI = 0.90-1.28; ε3 versus ε2: OR = 1.00, 95 % CI = 0.96-1.04) for APOE polymorphism and SAH susceptibility. In the subgroup analyzed that was stratified by ethnicity, increased risk of SAH was found in Asian subjects when ε4 allele compared with ε3 allele (ε4 vs ε3, OR = 1.55, 95 % CI = 1.07-2.52). CONCLUSIONS Our meta-analysis suggested that there is no association between APOE polymorphism and SAH risk for overall population. Due to several limitations in the present study, well-designed epidemiological studies with large sample size among different ethnicities should be performed in the future.
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Affiliation(s)
- Di Zhao
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenhai Zhang
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, Military General Hospital of Beijing PLA, Beijing, China
| | - Guo-Biao Wu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong-Yu Wang
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan City, China
| | - Fei Gao
- Centralized Procurement Center for Medical Instruments of Hebei, Shijiazhuang, China
| | - Xu-Dong Duan
- Department of TCM Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Zhi-Ming Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 West Heping Road, Shijiazhuang, 050005, China
| | - Dian-Ping You
- Hebei Medical Science and Technology Development Research Center, Shijiazhuang, China
| | - Yi Qu
- Institute of Medical Information of Hebei, Shijiazhuang, China
| | - Jian Song
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 West Heping Road, Shijiazhuang, 050005, China.
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Csajbok LZ, Nylén K, Öst M, Blennow K, Zetterberg H, Nellgård P, Nellgård B. Apolipoprotein E polymorphism in aneurysmal subarachnoid haemorrhage in West Sweden. Acta Neurol Scand 2016; 133:466-74. [PMID: 26374096 DOI: 10.1111/ane.12487] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Aneurysmal subarachnoid haemorrhage (aSAH) is associated with high morbidity and mortality despite novel treatments. Genetic variability may explain outcome differences. Apolipoprotein E (ApoE) is a glycoprotein with a major role in brain lipoprotein metabolism. It has three isoforms encoded by distinct alleles: APOEε2, APOEε3 and APOEε4. The APOEε4 allele is associated with Alzheimer's disease and worse outcome after traumatic brain injury and ischaemic stroke. This prospective blinded study explored the influence of the APOEε4 polymorphism on the risk of aSAH, risk of cerebral vasospasm (CVS) and 1-year neurological outcome. METHODS The APOΕε4 polymorphism was analysed in 147 patients with aSAH. Allele and genotype frequencies were compared to those found in a gender- and area-matched control group of healthy individuals (n = 211). Early CVS was identified and treated according to neurointensive care unit (NICU) guidelines. Neurological deficit(s) at admittance and at 1-year follow-up visit was recorded. Neurological outcome was assessed by the National Institute of Health Stroke Scale, Barthel Index and the Extended Glasgow Outcome Scale. RESULTS APOEε4 and non-APOEε4 allele frequencies were similar in aSAH patients and healthy individuals. The presence of APOEε4 was not associated with the development of early CVS. We could not find an influence of the APOE polymorphism on 1-year neurological outcome between groups. Subgroup analyses of patients treated with surgical clipping vs endovascular coiling did not reveal any associations. CONCLUSIONS The APOEε4 polymorphism has no major influence on risk of aSAH, the occurrence of CVS or long-term neurological outcome after aSAH.
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Affiliation(s)
- L. Z. Csajbok
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - K. Nylén
- Department of Neurology; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - M. Öst
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - K. Blennow
- Clinical Neurochemistry Laboratory; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
| | - H. Zetterberg
- Clinical Neurochemistry Laboratory; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
- UCL Institute of Neurology; Queen Square London UK
| | - P. Nellgård
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - B. Nellgård
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
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