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Yu Z, Xing J, Wang B, Hang H, Ye S. Development of a predictive model for prolonged length of stay in conservatively treated patients with spontaneous intracerebral hemorrhage: A retrospective study. J Clin Neurosci 2025; 136:111222. [PMID: 40215910 DOI: 10.1016/j.jocn.2025.111222] [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: 01/28/2025] [Revised: 03/20/2025] [Accepted: 03/31/2025] [Indexed: 05/17/2025]
Abstract
OBJECTIVE Spontaneous intracerebral hemorrhage (ICH) is a major cause of stroke-related morbidity and mortality, with prolonged length of stay (PLOS) contributing significantly to patient outcomes and healthcare costs. This study aims to identify the independent risk factors associated with prolonged length of stay in conservatively treated patients with ICH and to develop a predictive model to assist in clinical decision-making. METHODS A retrospective analysis was conducted on 161 patients with spontaneous ICH admitted to the Second Affiliated Hospital of Wannan Medical College between January 2021 and December 2022. Demographic, clinical, and laboratory data were collected. Factors influencing prolonged length of stay were identified using multivariate logistic regression analysis. A nomogram was developed to predict PLOS, and its performance was evaluated using receiver operating characteristic (ROC) curves, and decision curve analysis. RESULTS Patients in the PLOS group (n = 26, 16.1 %) had significantly higher NIHSS score, systolic blood pressure, rates of in-hospital pulmonary infections, and white blood cell counts, as well as lower ADL score, compared to those in the non-PLOS group (n = 135, 83.9 %). Multivariate logistic regression identified in-hospital pulmonary infection (OR = 4.548, 95 % CI: 1.529-13.530,P = 0.006), NIHSS score (OR = 1.106, 95 % CI: 1.017-1.203,P = 0.018), ADL score (OR =0.974, 95 % CI: 0.953-0.996,P = 0.022), and systolic blood pressure (OR = 1.019, 95 % CI: 1.000-1.038,P = 0.045) as independent risk factors for PLOS. The developed nomogram demonstrated strong discriminatory ability with an AUC of 0.845, outperforming individual factors. The model also showed good calibration and a higher net benefit, especially when the threshold probabilities were between 10 % and 80 %. CONCLUSION A predictive nomogram incorporating NIHSS score, ADL score, systolic blood pressure, and in-hospital pulmonary infection can effectively identify patients at risk for prolonged length of stay after spontaneous ICH. This model can guide clinicians in early intervention strategies and resource allocation, ultimately reducing healthcare costs and improving patient outcomes.
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Affiliation(s)
- Zhong Yu
- Neurosurgery Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China; Medical Records Management Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Jingjing Xing
- Emergency Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Bing Wang
- Emergency Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Hua Hang
- Medical Records Management Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Sheng Ye
- Emergency Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China.
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Wang Z, Ren Y, Liu W, Li J, Li J, Zhang C, Wang L, Zhou M, Hao J, Yin P, Ma Q. National and Subnational Trends of Mortality and Years of Life Lost Due to Stroke and Its Subtypes in Young Adults in China, 2005-2020. Neurology 2024; 103:e209982. [PMID: 39454122 PMCID: PMC11515115 DOI: 10.1212/wnl.0000000000209982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/27/2024] [Indexed: 10/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of stroke among young adults was rising globally, but the death burden of stroke in young adults in China is lacking. We aimed to examine the temporal trends in mortality and years of life lost (YLLs) caused by stroke among young adults from 2005 to 2020 across China. METHODS Based on the data from the National Mortality Surveillance System in China, we estimated the number and age-standardized rate of mortality and YLLs due to stroke and its subtypes among young adults aged 15-49 years during 2005-2020, for both China and its 31 mainland provinces. RESULTS During 2005-2020, the age-standardized mortality rate of stroke among young adults aged 15-49 years in China decreased by 21.0%, from 5.9/100,000 to 4.7/100,000, and the YLL rate decreased from 286.9/100,000 to 229.5/100,000. The age-standardized mortality rate among young adults due to intracerebral hemorrhage (ICH) showed a significant downward trend with a decrease of 26.3% while that of ischemic stroke (IS) and subarachnoid hemorrhage (SAH) decreased by 4.5% and 0.6%, respectively. In 2020, the mortality rate of ICH was 3.5 times higher than that of IS (3.3/100,000 vs 0.9/100,000) among young adults in China. The male/female ratio of age-standardized mortality rate of stroke in young adults increased from 2.0 in 2005 to 3.1 in 2020. The age-standardized mortality rate of IS and SAH in young men increased by 11.0% and 2.5%, respectively. In 2020, Tibet (18.4/100,000), Jilin (10.4/100,000), and Qinghai (8.3/100,000) were the top 3 provinces holding the highest age-standardized mortality rate due to stroke among young adults. Tibet was found to have the highest mortality rate due to ICH and SAH while that of IS was higher in northeast China. DISCUSSION In China, the death burden caused by ICH among young adults was substantially higher than that of IS. The increasing death burden of IS and SAH among young men requires special attention. Evidence-based intervention strategies are needed to improve the outcomes of stroke and alleviate the death burden due to stroke among young adults in Chinese population.
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Affiliation(s)
| | | | - Wei Liu
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiamin Li
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiameng Li
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhang
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
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Hwang DY, Kim KS, Muehlschlegel S, Wartenberg KE, Rajajee V, Alexander SA, Busl KM, Creutzfeldt CJ, Fontaine GV, Hocker SE, Madzar D, Mahanes D, Mainali S, Sakowitz OW, Varelas PN, Weimar C, Westermaier T, Meixensberger J. Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage. Neurocrit Care 2024; 40:395-414. [PMID: 37923968 PMCID: PMC10959839 DOI: 10.1007/s12028-023-01854-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH) neuroprognostication. METHODS A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format. RESULTS Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality. CONCLUSIONS These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
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Affiliation(s)
- David Y Hwang
- Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA.
| | - Keri S Kim
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Susanne Muehlschlegel
- Division of Neurosciences Critical Care, Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | | | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Gabriel V Fontaine
- Departments of Pharmacy and Neurosciences, Intermountain Health, Salt Lake City, UT, USA
| | - Sara E Hocker
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Dominik Madzar
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, Charlottesville, VA, USA
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Oliver W Sakowitz
- Department of Neurosurgery, Neurosurgery Center Ludwigsburg-Heilbronn, Ludwigsburg, Germany
| | | | - Christian Weimar
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
- BDH-Klinik Elzach, Elzach, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper-Kliniken Dachau, University of Wuerzburg, Würzburg, Germany
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Chen Y, Ma Y, Qin J, Wei X, Yang Y, Yuan Y, Yan F, Huo X, Han L. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 2024; 271:1160-1169. [PMID: 38036920 DOI: 10.1007/s00415-023-12054-w] [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: 08/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. OBJECTIVE To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. METHODS Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. RESULTS This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. CONCLUSIONS This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.
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Affiliation(s)
- Yajing Chen
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
| | - Jiangxia Qin
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yue Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China.
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Wan Y, He QW, Chen S, Li M, Xia Y, Zhang L, Sun Z, Chen X, Wang D, Chang J, Hu B. Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study. JMIR Public Health Surveill 2023; 9:e34386. [PMID: 38090794 PMCID: PMC10720699 DOI: 10.2196/34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/19/2023] [Accepted: 09/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH). OBJECTIVE This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH. METHODS Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups. RESULTS From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality. CONCLUSIONS Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817.
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Affiliation(s)
- Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolu Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - David Wang
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Jiang Chang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Makkiyah FA, Dicha S, Nurrizzka RH. A Single-Center Experience of Correlation of Pulse Pressure to Mortality of Stroke Hemorrhage Patients in Indonesia. ScientificWorldJournal 2023; 2023:5517493. [PMID: 37593547 PMCID: PMC10432090 DOI: 10.1155/2023/5517493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction The relationship between pulse pressure and mortality in acute stroke hemorrhage patients is a subject of debate. To investigate this relationship in the Indonesian context, a study was conducted due to the increasing prevalence of stroke in the country. Methods The study sample consisted of 111 patients with acute stroke hemorrhage admitted to the hospital between January 1, 2016, and December 31, 2019. Patients with sepsis, cancer, or other hematology disorders were excluded, as were those who were lost to follow-up. Statistical analysis was performed using SPSS 22, and correlations were evaluated between various patient characteristics and laboratory values. Results It was revealed that patients with a wider pulse pressure were more likely to die (adjusted odds ratio = 3,070) than those with a normal or constricted pulse pressure. Conclusion Pulse pressure had an impact on the mortality of patients with acute hemorrhagic stroke.
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Affiliation(s)
- Feda Anisah Makkiyah
- Department of Neurosurgery, Universitas Pembangunan Nasional Veteran Jakarta, Jalan RS Fatmawati No. 1 Pondok Labu, Jakarta 12520, Indonesia
| | - Saraah Dicha
- Department of Neurosurgery, Universitas Pembangunan Nasional Veteran Jakarta, Jalan RS Fatmawati No. 1 Pondok Labu, Jakarta 12520, Indonesia
| | - Rahmah Hida Nurrizzka
- Faculty of Public Health, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Jakarta Selatan, Indonesia
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de Mendiola JMFP, Arboix A, García-Eroles L, Sánchez-López MJ. Acute Spontaneous Lobar Cerebral Hemorrhages Present a Different Clinical Profile and a More Severe Early Prognosis than Deep Subcortical Intracerebral Hemorrhages-A Hospital-Based Stroke Registry Study. Biomedicines 2023; 11:223. [PMID: 36672731 PMCID: PMC9856131 DOI: 10.3390/biomedicines11010223] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Acute spontaneous intracerebral hemorrhage (ICH) is the most severe stroke subtype, with a high risk of death, dependence, and dementia. Knowledge about the clinical profile and early outcomes of ICH patients with lobar versus deep subcortical brain topography remains limited. In this study, we investigated the effects of ICH topography on demographics, cerebrovascular risk factors, clinical characteristics, and early outcomes in a sample of 298 consecutive acute ICH patients (165 with lobar and 133 with subcortical hemorrhagic stroke) available in a single-center-based stroke registry over 24 years. The multiple logistic regression analysis shows that variables independently associated with lobar ICH were early seizures (OR 6.81, CI 95% 1.27−5.15), chronic liver disease (OR 4.55, 95% CI 1.03−20.15), hemianopia (OR 2.55, 95% CI 1.26−5.15), headaches (OR 1.90, 95% CI 1.90, 95% IC 1.06−3.41), alcohol abuse (>80 gr/day) (OR 0−10, 95% CI 0.02−0,53), hypertension (OR 0,41, 95% CI 0.23−0−70), sensory deficit (OR 0.43, 95% CI 0.25−0.75), and limb weakness (OR: 0.47, 95% CI 0.24−0.93). The in-hospital mortality was 26.7% for lobar and 16.5% for subcortical ICH. The study confirmed that the clinical spectrum, prognosis, and early mortality of patients with ICH depend on the site of bleeding, with a more severe early prognosis in lobar intracerebral hemorrhage.
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Affiliation(s)
| | - Adrià Arboix
- Department of Neurology, Hospital Universitari Sagrat Cor, Universitat de Barcelona, 08029 Barcelona, Spain
| | - Luís García-Eroles
- Department of Neurology, Hospital Universitari Sagrat Cor, Universitat de Barcelona, 08029 Barcelona, Spain
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d’Annunzio A, Arboix A, García-Eroles L, Sánchez-López MJ. Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry. Biomedicines 2022; 10:2830. [PMID: 36359352 PMCID: PMC9687911 DOI: 10.3390/biomedicines10112830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited. OBJECTIVES In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated. METHODS A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry. RESULTS Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24-9.64), nausea or vomiting (OR 4.48, CI 95% 2.95-6.82), medulla (OR 2.87, CI 95% 1.31-6.30), pons (OR 2.39, CI 95% 1.26-4.51), basilar artery (OR 2.36, CI 95% 1.33-4.17), ataxia (OR 2.33, CI 95% 1.41-3.85), and headache (OR 2.31, CI 95% 1.53-3.49). CONCLUSION The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem.
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Affiliation(s)
- Angela d’Annunzio
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - Adrià Arboix
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - Luís García-Eroles
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - María-José Sánchez-López
- Medical Library, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
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Xu X, Peng S, Zhou Y, Li J, Tong L, Gao F. Remote diffusion-weighted imaging lesions and blood pressure variability in primary intracerebral hemorrhage. Front Neurol 2022; 13:950056. [PMID: 36203972 PMCID: PMC9530136 DOI: 10.3389/fneur.2022.950056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of this study was to examine the association between remote diffusion-weighted imaging lesions (R-DWILs) and blood pressure variability (BPV) in patients with primary intracerebral hemorrhage (ICH).MethodsWe conducted a retrospective review of a consecutive cohort of 375 patients with primary ICH within 24 h onset. R-DWILs were defined as hyperintensity lesions in DWI remote from the hematoma. Blood pressure recordings were extracted up to 24 h post-admission. BPV was measured using SD, coefficient of variation (CV), and successive variation (SV).ResultsRemote DWI lesions were detected in 65 (17.3%) primary ICH patients. In multivariable logistic regression analysis, parameters of BPV were independently associated with R-DWILs, and the results remained consistent after being adjusted with mean SBP. SD, CV, and SV values in the highest quintile, showed 3- to 8-fold increased risk of R-DWILs, compared with the lowest quintile. ΔSBP demonstrated a significant difference in 2 different predictive models. Max SBP only dictated a significant difference in model 1. Mean SBP, admission SBP, and min SBP, failed to present an association with R-DWILs in model 1 or model 2.ConclusionOur results provided additional evidence that BPV is associated with the development of R-DWILs in primary ICH.
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Affiliation(s)
- Xuhua Xu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Shuangshuang Peng
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurology, Taizhou First People's Hospital, Taizhou, China
| | - Yanli Zhou
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurology, Taizhou First People's Hospital, Taizhou, China
| | - Jiawen Li
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lusha Tong
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Lusha Tong
| | - Feng Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Feng Gao
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Guo QH, Liu CH, Wang JG. Blood Pressure Goals in Acute Stroke. Am J Hypertens 2022; 35:483-499. [PMID: 35323883 PMCID: PMC9203067 DOI: 10.1093/ajh/hpac039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 01/27/2023] Open
Abstract
Antihypertensive treatment is highly effective in both primary and secondary prevention of stroke. However, current guideline recommendations on the blood pressure goals in acute stroke are clinically empirical and generally conservative. Antihypertensive treatment is only recommended for severe hypertension. Several recent observational studies showed that the relationship between blood pressure and unfavorable clinical outcomes was probably positive in acute hemorrhagic stroke but J- or U-shaped in acute ischemic stroke with undetermined nadir blood pressure. The results of randomized controlled trials are promising for blood pressure management in hemorrhagic stroke but less so in ischemic stroke. A systolic blood pressure goal of 140 mm Hg is probably appropriate for acute hemorrhagic stroke. The blood pressure goal in acute ischemic stroke, however, is uncertain, and probably depends on the time window of treatment and the use of revascularization therapy. Further research is required to investigate the potential benefit of antihypertensive treatment in acute stroke, especially with regard to the possible reduction of blood pressure variability and more intensive blood pressure lowering in the acute and subacute phases of a stroke, respectively.
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Affiliation(s)
- Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chu-Hao Liu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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11
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Frequency, Predictors, Etiology, and Outcomes for Deep Intracerebral Hemorrhage without Hypertension. J Stroke Cerebrovasc Dis 2022; 31:106293. [PMID: 35016096 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106293] [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: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Some patients with deep intracerebral hemorrhage (ICH) have a transient hypertensive response and they may be erroneously classified as secondary to hypertension. We investigated frequency, risk factors, and outcomes for patients with deep ICH without hypertension. MATERIALS AND METHODS We consecutively recruited patients with spontaneous ICH attending two Spanish stroke centers (January 2015-June 2019). Excluded were patients with lobar/infratentorial ICH and patients who died during hospitalization. We defined deep ICH without hypertension when the bleeding was in a deep structure, no requirement for antihypertensive agents during follow-up and no evident chronic hypertension markers evaluated by transthoracic echocardiography, 24 h ambulatory blood pressure monitoring and/or electrocardiography. We compared clinical, radiological, and 3-month functional outcome data for deep-ICH patients with hypertension versus those without hypertension. RESULTS Of 759 patients with ICH, 219 (mean age 69.6 ± 15.4 years, 54.8% men) met the inclusion criteria and 36 (16.4%) did not have hypertension. Of these 36 patients, 19 (52.7%) had a transient hypertensive response. Independent predictors of deep ICH without hypertension were age (adjusted OR:0.94;95%CI:0.91-0.96) and dyslipidemia (adjusted OR:0.27;95% CI:0.08-0.85). One third of deep ICH without hypertension were secondary to vascular malformations. Favorable outcomes (modified Rankin Scale 0-2) were more frequent in patients with deep ICH without hypertension compared to those with hypertension (70.9% vs 33.8%; p < 0.001). CONCLUSION Of patients with deep ICH, 16.4% were unrelated with hypertension, around half showed hypertensive response, and around a third had vascular malformations. We suggest studying hypertension markers and performing a follow-up brain MRI in those patients with deep ICH without prior hypertension.
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12
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Guo Y, Zhang Y, Hou Y, Guo P, Wang X, Zhang S, Yang P. Anticonstriction Effect of MCA in Rats by Danggui Buxue Decoction. Front Pharmacol 2021; 12:749915. [PMID: 34867357 PMCID: PMC8634798 DOI: 10.3389/fphar.2021.749915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Danggui Buxue decoction (DBD), consisting of Angelicae Sinensis Radix (ASR) and Astragali Radix (AR), is a famous prescription with the function of antivasoconstriction. This study intends to probe its mechanisms on the relaxation of the middle cerebral artery (MCA). Methods: Vascular tension of rat MCA was measured using a DMT620 M system. First, the identical series of concentrations of DBD, ASR, and AR were added into resting KCl and U46619 preconstricted MCA. According to the compatibility ratio, their dilatation effects were further investigated on KCl and U46619 preconstricted vessels. Third, four K+ channel blockers were employed to probe the vasodilator mechanism on KCl-contracted MCA. We finally examined the effects of DBD, ASR, and AR on the vascular tone of U46619-contracted MCA in the presence or absence of Ca2+. Results: Data suggested that DBD, ASR, and AR can relax on KCl and U46619 precontracted MCA with no effects on resting vessels. The vasodilator effect of ASR was greater than those of DBD and AR on KCl-contracted MCA. For U46619-contracted MCA, ASR showed a stronger vasodilator effect than DBD and AR at low concentrations, but DBD was stronger than ASR at high concentrations. Amazingly, the vasodilator effect of DBD was stronger than that of AR at all concentrations on two vasoconstrictors which evoked MCA. The vasodilator effect of ASR was superior to that of DBD at a compatibility ratio on KCl-contracted MCA at low concentrations, while being inferior to DBD at high concentrations. However, DBD exceeded AR in vasodilating MCA at all concentrations. For U46619-constricted MCA, DBD, ASR, and AR had almost identical vasodilation. The dilation of DBD and AR on KCl-contracted MCA was independent of K+ channel blockers. However, ASR may inhibit the K+ channel opening partially through synergistic interactions with Gli and BaCl2. DBD, ASR, and AR may be responsible for inhibiting [Ca2+]out, while ASR and AR can also inhibit [Ca2+]in. Conclusion: DBD can relax MCA with no effects on resting vessels. The mechanism may be related to ASR’s inhibition of KATP and Kir channels. Meanwhile, the inhibition of [Ca2+]out by DBD, ASR, and AR as well as the inhibition of [Ca2+]in by ASR and AR may contribute to dilate MCA.
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Affiliation(s)
- Ying Guo
- School of Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu Fifth People's Hospital, Chengdu, China
| | - Yating Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ya Hou
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pengmei Guo
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sanyin Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Peng Yang
- Chengdu Fifth People's Hospital, Chengdu, China
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Hawkes MA, Rabinstein AA. Acute Hypertensive Response in Patients With Acute Intracerebral Hemorrhage: A Narrative Review. Neurology 2021; 97:316-329. [PMID: 34031208 DOI: 10.1212/wnl.0000000000012276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review the role of the acute hypertensive response in patients with intracerebral hemorrhage, current treatment options, and areas for further research. METHODS Review of the literature to assess 1) frequency of acute hypertensive response in intracerebral hemorrhage; 2) consequences of acute hypertensive response in clinical outcomes; 3) acute hypertensive response and secondary brain injury: hematoma expansion and perihematomal edema; 4) vascular autoregulation, safety data side effects of acute antihypertensive treatment; and 5) randomized clinical trials and meta-analyses. RESULTS An acute hypertensive response is frequent in patients with acute intracerebral hemorrhage and is associated with poor clinical outcomes. However, it is not clear whether high blood pressure is a cause of poor clinical outcome or solely represents a marker of severity. Although current guidelines recommend intensive blood pressure treatment (<140 mm Hg) in patients with intracerebral hemorrhage, 2 randomized clinical trials have failed to demonstrate a consistent clinical benefit from this approach, and new data suggest that intensive blood pressure treatment could be beneficial for some patients but detrimental for others. CONCLUSIONS Intracerebral hemorrhage is a heterogenous disease, thus, a one-fit-all approach for blood pressure treatment may be suboptimal. Further research should concentrate on finding subgroups of patients more likely to benefit from aggressive blood pressure lowering, considering intracerebral hemorrhage etiology, ultra-early randomization, and risk markers of hematoma expansion on brain imaging.
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Affiliation(s)
- Maximiliano A Hawkes
- From the Department of Neurological Sciences (M.A.H.), University of Nebraska Medical Center, Omaha; and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN.
| | - Alejandro A Rabinstein
- From the Department of Neurological Sciences (M.A.H.), University of Nebraska Medical Center, Omaha; and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN
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Arboix A. Hypertension and the acute phase of intracerebral haemorrhage: more evidence of the 'silent killer'. Eur J Neurol 2018; 25:1007-1008. [PMID: 29603497 DOI: 10.1111/ene.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
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