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Olsen MH, Capion T, Riberholt CG, Bache S, Ebdrup SR, Rasmussen R, Mathiesen T, Berg RMG, Møller K. Effect of controlled blood pressure increase on cerebral blood flow velocity and oxygenation in patients with subarachnoid haemorrhage. Acta Anaesthesiol Scand 2023; 67:1054-1060. [PMID: 37192754 DOI: 10.1111/aas.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Patients with aneurysmal subarachnoid haemorrhage (SAH) might have impaired cerebral autoregulation, that is, CBF - and thereby oxygen delivery - passively increase with an increase in CPP. This physiological study aimed to investigate the cerebral haemodynamic effects of controlled blood pressure increase in the early phase after SAH before any signs of delayed cerebral ischaemia (DCI) occurred. METHODS The study was carried out within 5 days after ictus. Data were recorded at baseline and after 20 min of noradrenaline infusion to increase mean arterial blood pressure (MAP) by a maximum of 30 mmHg and to an absolute level of no more than 130 mmHg. The primary outcome was the difference in middle cerebral artery blood flow velocity (MCAv) measured by transcranial Doppler (TCD), while differences in intracranial pressure (ICP), brain tissue oxygen tension (PbtO2 ), and microdialysis markers of cerebral oxidative metabolism and cell injury were assessed as exploratory outcomes. Data were analysed using Wilcoxon signed-rank test with correction for multiplicity for the exploratory outcomes using the Benjamini-Hochberg correction. RESULTS Thirty-six participants underwent the intervention 4 (median, IQR: 3-4.75) days after ictus. MAP was increased from 82 (IQR: 76-85) to 95 (IQR: 88-98) mmHg (p-value: <.001). MCAv remained stable (baseline, median 57, IQR: 46-70 cm/s; controlled blood pressure increase, median: 55, IQR: 48-71 cm/s; p-value: .054), whereas PbtO2 increased significantly (baseline, median: 24, 95%CI: 19-31 mmHg; controlled blood pressure increase, median: 27, 95%CI: 24-33 mmHg; p-value <.001). The remaining exploratory outcomes were unchanged. CONCLUSION In this study of patients with SAH, MCAv was not significantly affected by a brief course of controlled blood pressure increase; despite this, PbtO2 increased. This suggests that autoregulation might not be impaired in these patients or other mechanisms could mediate the increase in brain oxygenation. Alternatively, a CBF increase did occur that, in turn, increased cerebral oxygenation, but was not detected by TCD. TRIAL REGISTRATION clinicaltrials.gov (NCT03987139; 14 June 2019).
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Affiliation(s)
- Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Tenna Capion
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christian Gunge Riberholt
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Søren Røddik Ebdrup
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Rune Rasmussen
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ronan M G Berg
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Denmark
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Beske RP, Bache S, Abild Stengaard Meyer M, Kjærgaard J, Bro-Jeppesen J, Obling L, Olsen MH, Rossing M, Nielsen FC, Møller K, Nielsen N, Hassager C. MicroRNA-9-3p: a novel predictor of neurological outcome after cardiac arrest. Eur Heart J Acute Cardiovasc Care 2022; 11:609-616. [PMID: 35695264 DOI: 10.1093/ehjacc/zuac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
AIMS Resuscitated out-of-hospital cardiac arrest (OHCA) patients who remain comatose after hospital arrival are at high risk of mortality due to anoxic brain injury. MicroRNA are small-non-coding RNA molecules ultimately involved in gene-silencing. They show promise as biomarkers, as they are stable in body fluids. The microRNA 9-3p (miR-9-3p) is associated with neurological injury in trauma and subarachnoid haemorrhage. METHODS AND RESULTS This post hoc analysis considered all 171 comatose OHCA patients from a single centre in the target temperature management (TTM) trial. Patients were randomized to TTM at either 33°C or 36°C for 24 h. MicroRNA-9-3p (miR-9-3p) was measured in plasma sampled at admission and at 28, 48, and 72 h. There were no significant differences in age, gender, and pre-hospital data, including lactate level at admission, between miR-9-3p level quartiles. miR-9-3p levels changed markedly following OHCA with a peak at 48 h. Median miR-9-3p levels between TTM 33°C vs. 36°C were not different at any of the four time points. Elevated miR-9-3p levels at 48 h were strongly associated with an unfavourable neurological outcome [OR: 2.21, 95% confidence interval (CI): 1.64-3.15, P < 0.0001). MiR-9-3p was inferior to neuron-specific enolase in predicting functional neurological outcome [area under the curve: 0.79 (95% CI: 0.71-0.87) vs. 0.91 (95% CI: 0.85-0.97)]. CONCLUSION MiR-9-3p is strongly associated with neurological outcome following OHCA, and the levels of miR-9-3p are peaking 48 hours following cardiac arrest.
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Affiliation(s)
- Rasmus Paulin Beske
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Martin Abild Stengaard Meyer
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Laust Obling
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maria Rossing
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen: Copenhagen, Denmark
| | | | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen: Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Clinical Sciences at Helsingborg, Lund University, Lund, Sweden
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Olsen MH, Capion T, Riberholt CG, Bache S, Berg RMG, Møller K. Reliability of cerebral autoregulation using different measures of perfusion pressure in patients with subarachnoid hemorrhage. Physiol Rep 2022; 10:e15203. [PMID: 35343649 PMCID: PMC8958499 DOI: 10.14814/phy2.15203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 05/29/2023] Open
Abstract
Dynamic cerebral autoregulation to spontaneous fluctuations in cerebral perfusion pressure (CPP) is often assessed by transcranial Doppler (TCD) in the time domain, yielding primarily the mean flow index (Mx), or in the frequency domain using transfer function analysis (TFA), yielding gain and phase. For both domains, the measurement of blood pressure is critical. This study assessed the inter-method reliability of dynamic cerebral autoregulation using three different methods of pressure measurement. In 39 patients with aneurysmal subarachnoid hemorrhage, non-invasive arterial blood pressure (ABP), invasive ABP (measured in the radial artery) and CPP were recorded simultaneously with TCD. Intraclass correlation coefficient (ICC) was used to quantify reliability. Mx was higher when calculated using invasive ABP (0.39; 95% confidence interval [95% CI]: 0.33; 0.44) compared to non-invasive ABP, and CPP. The overall ICC showed poor to good reliability (0.65; 95% CI: 0.11; 0.84; n = 69). In the low frequency domain, the comparison between invasively measured ABP and CPP showed good to excellent (normalized gain, ICC: 0.87, 95CI: 0.81; 0.91; n = 96; non-normalized gain: 0.89, 95% CI: 0.84; 0.92; n = 96) and moderate to good reliability (phase, ICC: 0.69, 95% CI: 0.55; 0.79; n = 96), respectively. Different methods for pressure measurement in the assessment of dynamic cerebral autoregulation yield different results and cannot be used interchangeably.
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Affiliation(s)
- Markus Harboe Olsen
- Department of NeuroanaesthesiologyThe Neuroscience CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Tenna Capion
- Department of NeurosurgeryThe Neuroscience CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Christian Gunge Riberholt
- Department of NeuroanaesthesiologyThe Neuroscience CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Department of Neurorehabilitation/Traumatic Brain Injury UnitThe Neuroscience CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Søren Bache
- Department of NeuroanaesthesiologyThe Neuroscience CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Ronan M. G. Berg
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Centre for Physical Activity ResearchRigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Neurovascular Research LaboratoryFaculty of Life Sciences and EducationUniversity of South WalesPontypriddUnited Kingdom
| | - Kirsten Møller
- Department of NeuroanaesthesiologyThe Neuroscience CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Institute of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Schleicher RL, Bevers MB, Rubin DB, Koch MJ, Bache S, Lissak IA, Patel AB, Rosenthal ES, Møller K, Kimberly WT. Early Brain Injury and Soluble ST2 After Nontraumatic Subarachnoid Hemorrhage. Stroke 2021; 52:e494-e496. [PMID: 34167327 DOI: 10.1161/strokeaha.121.035372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Riana L Schleicher
- Division of Neurocritical Care (R.L.S., D.B.R., I.A.L., E.S.R., W.T.K.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (R.L.S., W.T.K.), Massachusetts General Hospital, Boston
| | - Matthew B Bevers
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - Daniel B Rubin
- Division of Neurocritical Care (R.L.S., D.B.R., I.A.L., E.S.R., W.T.K.), Massachusetts General Hospital, Boston
| | - Matthew J Koch
- Department of Neurosurgery (M.J.K., A.B.P.), Massachusetts General Hospital, Boston.,Department of Neurosurgery, University of Illinois at Chicago (M.J.K.)
| | - Søren Bache
- Department of Neuroanaesthesiology, Rigshospitalet (S.B., K.M.), University of Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences (S.B., K.M.), University of Copenhagen, Denmark
| | - India A Lissak
- Division of Neurocritical Care (R.L.S., D.B.R., I.A.L., E.S.R., W.T.K.), Massachusetts General Hospital, Boston
| | - Aman B Patel
- Department of Neurosurgery (M.J.K., A.B.P.), Massachusetts General Hospital, Boston
| | - Eric S Rosenthal
- Division of Neurocritical Care (R.L.S., D.B.R., I.A.L., E.S.R., W.T.K.), Massachusetts General Hospital, Boston
| | - Kirsten Møller
- Department of Neuroanaesthesiology, Rigshospitalet (S.B., K.M.), University of Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences (S.B., K.M.), University of Copenhagen, Denmark
| | - W Taylor Kimberly
- Division of Neurocritical Care (R.L.S., D.B.R., I.A.L., E.S.R., W.T.K.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (R.L.S., W.T.K.), Massachusetts General Hospital, Boston
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5
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Engberg M, Bonde J, Sigurdsson ST, Møller K, Nayahangan LJ, Berntsen M, Eschen CT, Haase N, Bache S, Konge L, Russell L. Training non-intensivist doctors to work with COVID-19 patients in intensive care units. Acta Anaesthesiol Scand 2021; 65:664-673. [PMID: 33529356 PMCID: PMC8013477 DOI: 10.1111/aas.13789] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
Background Due to an expected surge of COVID‐19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID‐19 patients. A training course and a theoretical test for non‐intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course. Methods The 1‐day course was comprised of theoretical sessions and hands‐on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test). Results Fifty‐four non‐intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass–fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest. Conclusion Non‐intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1‐day evidence‐based course. This knowledge was largely retained as shown by a multiple‐choice test supported by validity evidence. The test is available in appendix and online.
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Affiliation(s)
- Morten Engberg
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Jan Bonde
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Sigurdur T. Sigurdsson
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Leizl J. Nayahangan
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Camilla T. Eschen
- Department of Cardiothoracic Anaesthesiology University of Copenhagen Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Søren Bache
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
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6
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Matzen JS, Krogh CL, Forman JL, Garred P, Møller K, Bache S. Lectin complement pathway initiators after subarachnoid hemorrhage - an observational study. J Neuroinflammation 2020; 17:338. [PMID: 33183322 PMCID: PMC7661172 DOI: 10.1186/s12974-020-01979-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background This exploratory study investigated the time-course of lectin complement pathway (LCP) initiators in cerebrospinal fluid (CSF) and plasma in patients with subarachnoid hemorrhage (SAH), as well as their relationship to delayed cerebral ischemia (DCI) and functional outcome. Methods Concentrations of ficolin-1, ficolin-2, ficolin-3, and mannose-binding lectin (MBL) were analyzed in CSF and plasma from patients with SAH. Samples were collected daily from admission until day 9 (CSF; N_PATIENTS = 63, n_SAMPLES = 399) and day 8 (plasma; N_PATIENTS = 50, n_SAMPLES = 358), respectively. Twelve neurologically healthy patients undergoing spinal anesthesia and 12 healthy blood donors served as controls. The development of DCI during hospitalization and functional outcome at 3 months (modified Rankin Scale) were registered for patients. Results On admission, CSF levels of all LCP initiators were increased in SAH patients compared with healthy controls. Levels declined gradually over days in patients; however, a biphasic course was observed for ficolin-1. Increased CSF levels of all LCP initiators were associated with a poor functional outcome in univariate analyses. This relationship persisted for ficolin-1 and MBL in multivariate analysis after adjustments for confounders (age, sex, clinical severity, distribution and amount of blood on CT-imaging) and multiple testing (1.87 ng/mL higher in average, 95% CI, 1.17 to 2.99 and 1.69 ng/mL higher in average, 95% CI, 1.09 to 2.63, respectively). In patients who developed DCI compared with those without DCI, CSF levels of ficolin-1 and MBL tended to increase slightly more over time (p_interaction = 0.021 and 0.033, respectively); however, no association was found after adjustments for confounders and multiple testing (p-adj_interaction = 0.086 and 0.098, respectively). Plasma ficolin-1 and ficolin-3 were lower in SAH patients compared with healthy controls on all days. DCI and functional outcome were not associated with LCP initiator levels in plasma. Conclusion Patients with SAH displayed elevated CSF levels of ficolin-1, ficolin-2, ficolin-3, and MBL. Increased CSF levels of ficolin-1 and MBL were associated with a poor functional outcome. Trial registration This study was a retrospective analysis of samples, which had been prospectively sampled and stored in a biobank. Registered at clinicaltrials.gov (NCT01791257, February 13, 2013, and NCT02320539, December 19, 2014). Supplementary Information The online version contains supplementary material available at 10.1186/s12974-020-01979-y.
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Affiliation(s)
- Jeppe Sillesen Matzen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 3, 2100, Copenhagen Ø, Denmark.
| | - Charlotte Loumann Krogh
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 3, 2100, Copenhagen Ø, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 3, 2100, Copenhagen Ø, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 3, 2100, Copenhagen Ø, Denmark
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7
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Arleth T, Olsen MH, Orre M, Rasmussen R, Bache S, Eskesen V, Frikke-Schmidt R, Møller K. Hypozincaemia is associated with severity of aneurysmal subarachnoid haemorrhage: a retrospective cohort study. Acta Neurochir (Wien) 2020; 162:1417-1424. [PMID: 32246202 DOI: 10.1007/s00701-020-04310-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hypozincaemia may develop in critically ill patients, including those with acute brain injury in the early phase after hospital admission. The aim of this study was to investigate the prevalence of hypozincaemia after aneurysmal subarachnoid haemorrhage (aSAH) and its association with delayed cerebral ischemia and functional outcome. METHODS We retrospectively analysed a cohort of 384 patients with SAH admitted to the Neurointensive Care Unit at Rigshospitalet, Copenhagen, Denmark, in whom at least one measurement of plasma zinc concentration was done during the hospital stay. Hypozincaemia was defined as at least one measurement of plasma zinc below 10 μmol/L. Potential associations between hypozincaemia, demographic variables and functional outcome after aSAH were analysed in multivariable logistic regression models. RESULTS Hypozincaemia was observed in 67% (n = 257) of all patients and occurred within 7 days in more than 95% of all hypozincaemic patients. In a multivariable model, severe SAH (WFNS 3-5; OR 4.2, CI 2.21-8.32, p < 0.001) and Sequential Organ Failure Assessment (SOFA) score on the day of admission (OR 1.24, CI 1.11-1.40, p < 0.001) were independently associated with hypozincaemia. In another multivariable model, hypozincaemia was independently associated with an unfavourable outcome (defined as a modified Rankin Scale score from 3 to 6) (OR 1.97, CI 1.06-3.68, p = 0.032), as was age (OR 1.03, CI 1.01-1.05, p = 0.015), SOFA score on the day of admission (OR 1.14, CI 1.02-1.29, p = 0.02), a diagnosis of delayed cerebral ischaemia (OR 4.06, CI 2.29-7.31, p < 0.001) and a clinical state precluding assessment for delayed cerebral ischaemia (OR 15.13, CI 6.59-38.03, p < 0.001). CONCLUSION Hypozincaemia occurs frequently after aSAH, is associated with a higher disease severity and independently contributes to an unfavourable outcome.
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Affiliation(s)
- Tobias Arleth
- Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matias Orre
- Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rune Rasmussen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vagn Eskesen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Bache S, Rasmussen R, Wolcott Z, Rossing M, Møgelvang R, Tolnai D, Hassager C, Forman JL, Køber L, Nielsen FC, Kimberly WT, Møller K. Elevated miR-9 in Cerebrospinal Fluid Is Associated with Poor Functional Outcome After Subarachnoid Hemorrhage. Transl Stroke Res 2020; 11:1243-1252. [PMID: 32248435 DOI: 10.1007/s12975-020-00793-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/10/2020] [Accepted: 02/19/2020] [Indexed: 12/13/2022]
Abstract
This study evaluated microRNA (miRNA) changes in cerebrospinal fluid (CSF) and their association with the occurrence of delayed cerebral ischemia (DCI) and poor functional outcome after SAH. Forty-three selected miRNAs were measured in daily CSF samples from a discovery cohort of SAH patients admitted to Rigshospitalet, Copenhagen, Denmark, and compared with neurologically healthy patients. Findings were validated in CSF from a replication cohort of SAH patients admitted to Massachusetts General Hospital, Boston, Massachusetts. The CSF levels of miRNA over time were compared with the occurrence of DCI, and functional outcome after 3 months. miRNAs were quantified in 427 CSF samples from 63 SAH patients in the discovery cohort, in 104 CSF samples from 63 SAH patients in the replication cohort, and in 11 CSF samples from 11 neurologically healthy patients. The miRNA profile changed remarkably immediately after SAH. Elevated miR-9-3p was associated with a poor functional outcome in the discovery cohort (p < 0.0001) after correction for multiple testing (q < 0.01) and in the replication cohort (p < 0.01). Furthermore, elevated miR-9-5p was associated with a poor functional outcome in the discovery cohort (p < 0.01) after correction for multiple testing (q < 0.05). No miRNA was associated with DCI in both cohorts. miR-9-3p and miR-9-5p are elevated in the CSF following SAH and this elevation is associated with a poor functional outcome. These elevations have potential roles in the progression of cerebral injury and could add to early prognostication.
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Affiliation(s)
- Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark. .,Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Rune Rasmussen
- Department of Neurosurgery, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark
| | - Zoe Wolcott
- Department of Neurology & Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Maria Rossing
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Tolnai
- Department of Radiology, The Diagnostic Centre, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - William T Kimberly
- Department of Neurology & Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Olsen MH, Orre M, Leisner ACW, Rasmussen R, Bache S, Welling K, Eskesen V, Møller K. Delayed cerebral ischaemia in patients with aneurysmal subarachnoid haemorrhage: Functional outcome and long-term mortality. Acta Anaesthesiol Scand 2019; 63:1191-1199. [PMID: 31173342 DOI: 10.1111/aas.13412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Delayed cerebral ischaemia (DCI) is one of the most frequent complications of aneurysmal subarachnoid haemorrhage (aSAH). The purpose of the present retrospective cohort study of patients with aSAH was to identify the association between DCI, functional outcome and 4-year mortality. METHODS Patients admitted to the Neurointensive Care Unit at Rigshospitalet, Copenhagen, with aSAH from 1 January 2010, through 31 December 2013 were registered. Patients were categorized into 3 groups: (a) those with DCI, defined as either a decline in consciousness or focal neurological deficits lasting ≥1 hour without any other detectable cause, (b) those without DCI, or (c) those who were unassessable for DCI. Functional neurological outcome after 6 months, as measured by the modified Rankin Scale (mRS), was dichotomized into good (mRS 0-2) and poor (mRS 3-6). Kaplan-Meier survival curves were constructed, and incidence risk rates were calculated both to determine the association between DCI and mortality. RESULTS Four hundred ninety-two cases of aSAH were recorded in the study period. DCI occurred in 23% of all patients, corresponding to 33% of assessable patients. Patients without DCI had the best functional outcome (mRS) compared to patients with DCI and patients who were unassessable; furthermore, the latter had worse outcomes than patients with DCI. Patients diagnosed with DCI had significantly higher mortality than those without DCI, even ignoring the first 14 days after admission. CONCLUSION DCI may be associated with both short- and long-term morbidity and mortality in patients with aSAH.
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Affiliation(s)
- Markus Harboe Olsen
- Department of Neuroanaesthesiology Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Matias Orre
- Department of Neuroanaesthesiology Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Anna Cold Winge Leisner
- Department of Neuroanaesthesiology Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Rune Rasmussen
- Department of Neurosurgery Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Søren Bache
- Department of Neuroanaesthesiology Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Karen‐Lise Welling
- Department of Neuroanaesthesiology Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Vagn Eskesen
- Department of Neurosurgery Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology Rigshospitalet, University of Copenhagen Copenhagen Denmark
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Bevers MB, Wolcott Z, Bache S, Hansen C, Sastre C, Mylvaganam R, Koch MJ, Patel AB, Møller K, Kimberly WT. Soluble ST2 links inflammation to outcome after subarachnoid hemorrhage. Ann Neurol 2019; 86:384-394. [PMID: 31291030 DOI: 10.1002/ana.25545] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate whether soluble growth stimulation expressed gene 2 (sST2), a prognostic marker in cardiovascular and inflammatory disorders, is associated with neurological injury after aneurysmal subarachnoid hemorrhage (SAH). METHODS We studied SAH patients from 2 independent cohorts. Outcome assessments included functional status at 90 days using the modified Rankin Scale (mRS), mortality, and delayed cerebral ischemia (DCI). The relationships between sST2 plasma level and outcome measures were assessed in both cross-sectional and longitudinal analysis. Primary blood mononuclear cells from SAH patients and elective aneurysm controls were analyzed by multiparameter flow cytometry. RESULTS In the discovery cohort, sST2 predicted 90-day mRS 3-6 (C index = 0.724, p < 0.001) and mortality in Kaplan-Meier analysis (p < 0.001). The association with functional status was independent of age, sex, World Federation of Neurosurgical Societies score, modified Fisher score, treatment modality, and cardiac comorbidities (adjusted odds ratio = 2.28, 95% confidence interval = 1.04-5.00, p = 0.039). Higher sST2 concentration was observed in those patients with DCI (90.8 vs 53.7ng/ml, p = 0.003). These associations were confirmed in a replication cohort. In patients with high sST2, flow cytometry identified decreased expression of CD14 (4.27 × 105 ± 2,950 arbitrary unit (AU) vs 5.64 × 105 ± 1,290 AU, p < 0.001), and increased expression of CD16 (39,960 ± 272 AU vs 34,869 ± 183 AU, p < 0.001). INTERPRETATION Plasma sST2 predicts DCI, functional outcome, and mortality after SAH, independent of clinical and radiographic markers. Elevated sST2 is also associated with changes in CD14+ CD16+ monocytes. ANN NEUROL 2019;86:384-394.
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Affiliation(s)
- Matthew B Bevers
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, MA
| | - Zoe Wolcott
- Division of Neurocritical Care, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Søren Bache
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Christina Hansen
- Division of Neurocritical Care, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Cristina Sastre
- Division of Neurocritical Care, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Ravi Mylvaganam
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Matthew J Koch
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA
| | - Kirsten Møller
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - W Taylor Kimberly
- Division of Neurocritical Care, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
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Olsen MH, Lilja-Cyron A, Bache S, Eskesen V, Møller K. [Aneurysmal subarachnoid haemorrhage]. Ugeskr Laeger 2019; 181:V01190019. [PMID: 31368433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this review is to increase the knowledge about diagnosis and treatment of aneurysmal subarachnoid haemorrhage (aSAH), which is an infrequent and critical condition with a high risk of severe morbidity and mortality. The outcome is improved by correct and efficient diagnosis and early treatment, including aneurysm repair. General practitioners and doctors in the departments for emergency medicine should be aware of the symptoms of aSAH.
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12
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Rasmussen R, Bache S, Stavngaard T, Møller K. Plasma Levels of IL-6, IL-8, IL-10, ICAM-1, VCAM-1, IFNγ, and TNFα are not Associated with Delayed Cerebral Ischemia, Cerebral Vasospasm, or Clinical Outcome in Patients with Subarachnoid Hemorrhage. World Neurosurg 2019; 128:e1131-e1136. [PMID: 31121365 DOI: 10.1016/j.wneu.2019.05.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Delayed cerebral ischemia (DCI) is a serious and frequent complication following subarachnoid hemorrhage (SAH). The pathophysiology behind DCI remains poorly understood, but inflammation has been proposed to play a significant role. This study investigated the relationship between plasma levels of some of the most important inflammatory markers and DCI, cerebral vasospasm, and functional outcome in patients with SAH. METHODS In 90 patients with SAH, interleukin-6, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, high sensitivity C-reactive protein (HsCRP), interleukin-8, interleukin-10, interferon gamma, and tumor necrosis factor alpha were measured in peripheral blood day 3 and day 8 after SAH. Any occurrence of DCI or infection was recorded, and computed tomography angiography was performed on day 8. Clinical outcome was assessed after 3 months. RESULTS HsCRP on day 3 was higher in patients with angiographic vasospasm (P = 0.003), and HsCRP on day 8 was higher in patients with poor outcome (P = 0.014). No association with DCI, vasospasm, or outcome was found for any of the remaining analyzed substances. CONCLUSIONS High plasma levels of HsCRP were significantly associated with angiographic vasospasm and clinical outcome. Plasma levels of interleukin-6, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, interleukin-8, interleukin-10, interferon gamma, and tumor necrosis factor alpha were not associated with DCI, angiographic vasospasm, or clinical outcome at 3 months.
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Affiliation(s)
- Rune Rasmussen
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Søren Bache
- Department of Neuroanesthesiology, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Trine Stavngaard
- Department of Radiology, The Diagnostic Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Bache S, Rasmussen R, Wolcott Z, Rossing M, Møgelvang R, Tolnai D, Hassager C, Forman JL, Køber L, Nielsen FC, Kimberly WT, Moller K. Abstract 149: Elevated mir-9 in Cerebrospinal Fluid is Associated With Poor Functional Outcome After Subarachnoid Hemorrhage. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Aneurysmal subarachnoid hemorrhage (SAH) has a lower incidence than ischemic stroke but affects younger individuals with a high mortality and a high frequency of complications in survivors. The underlying pathways that contribute to poor functional outcome are poorly understood.
Hypothesis:
MicroRNA (miRNA) changes in cerebrospinal fluid (CSF) are associated with the occurrence of delayed cerebral ischemia and poor functional outcome after SAH.
Methods:
Using real-time polymerase quantification chain reaction (RT-qPCR), 43 selected miRNAs were measured in daily CSF samples from a discovery cohort of SAH patients admitted to Rigshospitalet, Copenhagen, Denmark, and compared to neurologically healthy patients. Findings were validated in CSF from a replication cohort of SAH patients admitted to Massachusetts General Hospital, Boston, Massachusetts. Outcome measures were delayed cerebral ischemia (DCI), as well as functional outcome three months after ictus measured by the modified Rankin Scale score.
Results:
MiRNAs were quantified and passed RT-qPCR quality control in 427 CSF samples from 63 SAH patients in the discovery cohort, in 104 CSF samples from 63 SAH patients in the replication cohort and in 11 CSF samples from 11 neurologically healthy patients. Elevated miR-9-3p was associated with a poor functional outcome in both the discovery cohort (p < 0.0001) after correction for multiple testing (q < 0.01) and in the replication cohort (p < 0.01). Furthermore, elevated miR-9-5p was associated with a poor functional outcome in the discovery cohort (p < 0.01) after correction for multiple testing (q < 0.05). No miRNA was associated with DCI in both cohorts.
Conclusions:
Mir-9-3p is elevated in the CSF following SAH and this elevation is associated with a poor functional outcome.
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Affiliation(s)
- Søren Bache
- Dept of Neuroanesthesiology and Cntr for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Rune Rasmussen
- Dept of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Zoe Wolcott
- Dept of Neurology & Cntr for Genomic Medicine, Div of Neurocritical Care and Emergency Neurology, Massachusetts General Hosp, Boston, MA
| | - Maria Rossing
- Cntr for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | | | - Daniel Tolnai
- Dept of Radiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Julie Lyng Forman
- Section of Biostatistics, Dept of Public Healthy, Univeristy of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Dept of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - W. Taylor Kimberly
- Dept of Neurology & Cntr for Genomic Medicine, Div of Neurocritical Care and Emergency Neurology, Massachusetts General Hosp, Boston, MA
| | - Kirsten Moller
- Dept of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
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Wolcott Z, Bevers MB, Bache S, Irvine H, Koch M, Patel A, Møller K, Kimberly WT. Abstract 38: Soluble ST2 Predicts Delayed Cerebral Ischemia and Outcome After Subarachnoid Hemorrhage. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Soluble ST2 (sST2) is a member of the Toll-like receptor superfamily implicated in pro-inflammatory signaling. We investigated whether sST2 predicts delayed cerebral ischemia (DCI) and 90-day clinical outcome in patients with aneurysmal subarachnoid hemorrhage (SAH).
Methods:
Soluble ST2 was measured in plasma samples from 182 patients who presented to a single institution with SAH. Blood samples were collected between days 1 and 5 after onset of SAH, and prior to the onset of DCI. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS) with good and poor outcome defined as mRS 0-2 and 3-6, respectively. Using a consensus definition, DCI was defined as a 2-point drop in GCS over a sustained period in patients whose clinical deterioration could not be explained by another cause. The relationships between sST2 level, DCI and outcome were assessed in univariable analysis. Multivariable logistic regression, Kaplan-Meier survival analysis, and receiver operating characteristic curves were used to determine the ability of sST2 to predict outcome and mortality. These findings were tested for replication in an independent cohort of 51 SAH patients recruited from a separate institution.
Results:
The discovery cohort consisted of 182 subjects (mean age 56±12 years, 61% women). Elevated plasma sST2 predicted the development of DCI (OR 2.10, 95% 1.06-4.18 CI, P=0.0295), which remained an independent predictor after adjustment for age, World Federation of Neurological Surgeons (WFNS) grading score, modified Fisher score, intra-arterial vasodilator therapy and hydrocephalus (OR 2.78, 95% CI 1.00-7.97, p=0.0453). Elevated sST2 was also independently associated with poor 90-day functional outcome (OR 2.65, 95%CI 1.07-6.59,
P
=0.0304), and mortality (OR 5.36, 95% CI 1.48-19.39, p=0.0039) when adjusted for age, WFNS score, modified Fisher score and hydrocephalus. In the replication cohort (N=51, 88% women), sST2 level was an independent predictor of DCI (OR 5.02, 95% CI 1.46-17.20, p=0.0034) and outcome at 90 days (OR 4.24, 95% CI 1.31-13.74, p=0.0072).
Conclusion:
Plasma sST2 level predicted risk of DCI, outcome, and mortality after SAH. Further study of the potential link between sST2 and brain injury after SAH is warranted.
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Krogh CL, Bache S, Garred P, Møller K. Markers of the lectin-complement pathway in patients with aneurysmal subarachnoid haemorrhage. Mol Immunol 2017. [DOI: 10.1016/j.molimm.2017.06.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Bache S, Rasmussen R, Rossing M, Laigaard FP, Nielsen FC, Møller K. MicroRNA Changes in Cerebrospinal Fluid After Subarachnoid Hemorrhage. Stroke 2017; 48:2391-2398. [PMID: 28768799 PMCID: PMC5571886 DOI: 10.1161/strokeaha.117.017804] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Delayed cerebral ischemia (DCI) accounts for a major part of the morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). MicroRNAs (miRNAs) are pathophysiologically involved in acute cerebral ischemia. This study compared miRNA profiles in cerebrospinal fluid from neurologically healthy patients, as well as SAH patients with and without subsequent development of DCI. Methods— In a prospective case–control study of SAH patients treated with external ventricular drainage and neurologically healthy patients, miRNA profiles in cerebrospinal fluid were screened and validated using 2 different high-throughput real-time quantification polymerase chain reaction techniques. The occurrence of DCI was documented in patient charts and subsequently reviewed independently by 2 physicians. Results— MiRNA profiles from 27 SAH patients and 10 neurologically healthy patients passed quality control. In the validation, 66 miRNAs showed a relative increase in cerebrospinal fluid from SAH patients compared with neurologically healthy patients (P<0.001); 2 (miR-21 and miR-221) showed a relative increase in SAH patients with DCI compared with those without (P<0.05) in both the screening and validation. Conclusions— SAH is associated with marked changes in the cerebrospinal fluid miRNA profile. These changes could be associated to the development of DCI. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01791257.
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Affiliation(s)
- Søren Bache
- From the Departments of Neuroanaesthesiology (S.B., K.M.) and Neurosurgery (R.R.), The Neuroscience Centre, and Centre for Genomic Medicine (S.B., M.R., F.C.N.), Rigshospitalet, and Department of Anaesthesia, Frederiksberg Hospital (F.P.L.), University of Copenhagen, Denmark.
| | - Rune Rasmussen
- From the Departments of Neuroanaesthesiology (S.B., K.M.) and Neurosurgery (R.R.), The Neuroscience Centre, and Centre for Genomic Medicine (S.B., M.R., F.C.N.), Rigshospitalet, and Department of Anaesthesia, Frederiksberg Hospital (F.P.L.), University of Copenhagen, Denmark
| | - Maria Rossing
- From the Departments of Neuroanaesthesiology (S.B., K.M.) and Neurosurgery (R.R.), The Neuroscience Centre, and Centre for Genomic Medicine (S.B., M.R., F.C.N.), Rigshospitalet, and Department of Anaesthesia, Frederiksberg Hospital (F.P.L.), University of Copenhagen, Denmark
| | - Finn Pedersen Laigaard
- From the Departments of Neuroanaesthesiology (S.B., K.M.) and Neurosurgery (R.R.), The Neuroscience Centre, and Centre for Genomic Medicine (S.B., M.R., F.C.N.), Rigshospitalet, and Department of Anaesthesia, Frederiksberg Hospital (F.P.L.), University of Copenhagen, Denmark
| | - Finn Cilius Nielsen
- From the Departments of Neuroanaesthesiology (S.B., K.M.) and Neurosurgery (R.R.), The Neuroscience Centre, and Centre for Genomic Medicine (S.B., M.R., F.C.N.), Rigshospitalet, and Department of Anaesthesia, Frederiksberg Hospital (F.P.L.), University of Copenhagen, Denmark
| | - Kirsten Møller
- From the Departments of Neuroanaesthesiology (S.B., K.M.) and Neurosurgery (R.R.), The Neuroscience Centre, and Centre for Genomic Medicine (S.B., M.R., F.C.N.), Rigshospitalet, and Department of Anaesthesia, Frederiksberg Hospital (F.P.L.), University of Copenhagen, Denmark
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Bache S, Liu X, Rong J. SU-G-206-08: How Should Focal Spot Be Chosen for Optimized CT Imaging with Dose Modulation? Med Phys 2016. [DOI: 10.1118/1.4956949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Bache S, Rong J. SU-G-206-02: Impact of Focal Spot Sizes On CT Image Quality. Med Phys 2016. [DOI: 10.1118/1.4956943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Bache S, Liu X, Loyer E, Rong J. TH-CD-207B-12: Quantification of Clinical Feedback On Image Quality Differences Between Two CT Scanner Models. Med Phys 2016. [DOI: 10.1118/1.4958218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Bache S, Loyer E, Stauduhar P, Liu X, Rong J. SU-E-I-22: A Comprehensive Investigation of Noise Variations Between the GE Discovery CT750 HD and GE LightSpeed VCT. Med Phys 2015. [DOI: 10.1118/1.4924019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bache S, Rasmussen R, Rossing M, Hammer NR, Juhler M, Friis-Hansen L, Nielsen FC, Møller K. Detection and quantification of microRNA in cerebral microdialysate. J Transl Med 2015; 13:149. [PMID: 25947950 PMCID: PMC4438475 DOI: 10.1186/s12967-015-0505-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/24/2015] [Indexed: 12/02/2022] Open
Abstract
Background Secondary brain injury accounts for a major part of the morbidity and mortality in patients with spontaneous aneurysmal subarachnoid hemorrhage (SAH), but the pathogenesis and pathophysiology remain controversial. MicroRNAs (miRNAs) are important posttranscriptional regulators of complementary mRNA targets and have been implicated in the pathophysiology of other types of acute brain injury. Cerebral microdialysis is a promising tool to investigate these mechanisms. We hypothesized that miRNAs would be present in human cerebral microdialysate. Methods RNA was extracted and miRNA profiles were established using high throughput real-time quantification PCR on the following material: 1) Microdialysate sampled in vitro from A) a solution of total RNA extracted from human brain, B) cerebrospinal fluid (CSF) from a neurologically healthy patient, and C) a patient with SAH; and 2) cerebral microdialysate and CSF sampled in vivo from two patients with SAH. MiRNAs were categorized according to their relative recovery (RR) and a pathway analysis was performed for miRNAs exhibiting a high RR in vivo. Results Seventy-one of the 160 miRNAs detected in CSF were also found in in vivo microdialysate from SAH patients. Furthermore specific miRNAs consistently exhibited either a high or low RR in both in vitro and in vivo microdialysate. Analysis of repeatability showed lower analytical variation in microdialysate than in CSF. Conclusions MiRNAs are detectable in cerebral microdialysate; a large group of miRNAs consistently showed a high RR in cerebral microdialysate. Measurement of cerebral interstitial miRNA concentrations may aid in the investigation of secondary brain injury in neurocritical conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0505-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Copenhagen, Denmark. .,Centre for Genomic Medicine, The Diagnostic Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rune Rasmussen
- Department of Neurosurgery, The Neuroscience Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Maria Rossing
- Centre for Genomic Medicine, The Diagnostic Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Niels Risør Hammer
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Marianne Juhler
- Department of Neurosurgery, The Neuroscience Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lennart Friis-Hansen
- Centre for Genomic Medicine, The Diagnostic Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. .,Present address: Department of Clinical Biochemistry, Naestved Sygehus, Naestved, Denmark.
| | - Finn Cilius Nielsen
- Centre for Genomic Medicine, The Diagnostic Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Copenhagen, Denmark.
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Rasmussen R, Bache S, Stavngaard T, Skjøth-Rasmussen J, Romner B. Real-time changes in brain tissue oxygen during endovascular treatment of cerebral vasospasm. Acta Neurochir Suppl 2015; 120:183-186. [PMID: 25366621 DOI: 10.1007/978-3-319-04981-6_31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The use of endovascular intervention to treat cerebral vasospasm after subarachnoid hemorrhage has increased. Although the effect on angiographic vasospasm can be easily demonstrated, the effect on cerebral blood flow and clinical outcome is still controversial. In this report, we investigate minute-by-minute changes in brain tissue oxygen during balloon angioplasty and intraarterial administration of vasodilators in three patients.Our results confirm that endovascular intervention is capable of not only resolving angiographic vasospasm, but also of normalizing values of brain tissue oxygen pressure (PtiO₂) in target parenchyma. However, during the intervention, dangerously low levels of brain tissue oxygen, leading to cerebral infarction, may occur. Thus, no clinical improvement was seen in two of the patients and a dramatic worsening was observed in the third patient. Because the decrease in brain tissue oxygen was seen after administration of vasopressor agents, this may be a contributing factor.
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Affiliation(s)
- Rune Rasmussen
- Department of Neurosurgery, Copenhagen University Hospital, 9 Blegdamsvej, Copenhagen, Denmark,
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Bache S, Malcolm J, Adamovics J, Oldham M. SU-E-J-164: An Investigation of a Low-Cost ‘dry’ Optical-CT Scanning System for 3D Dosimetry. Med Phys 2014. [DOI: 10.1118/1.4888217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Li Q, Juang T, Bache S, Chang S, Oldham M. SU-C-BRE-04: Microbeam-Radiation-Therapy (MRT): Characterizing a Novel MRT Device Using High Resolution 3D Dosimetry. Med Phys 2014. [DOI: 10.1118/1.4889710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bache S, Belley M, Benning R, Stanton I, Therien M, Yoshizumi T, Adamovics J, Oldham M. WE-F-16A-04: Micro-Irradiator Treatment Verification with High-Resolution 3D-Printed Rodent-Morphic Dosimeters. Med Phys 2014. [DOI: 10.1118/1.4889471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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Bache S, Juang T, Adamovics J, Benning R, Koontz B, Predmore K, Dewhirst M, Oldham M. WE-E-108-09: An Investigation of the Feasibility of Rodentmorphic 3D Dosimeters for Verification of Precision Micro-Irradiator Treatment. Med Phys 2013. [DOI: 10.1118/1.4815587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Bache S, Stendell L, Olsen N, Olsen K. Problems in obtaining sufficient anaesthesia with propofol and remifentanil: three cases, a test infusion, and a review. Br J Anaesth 2013; 110:741-6. [DOI: 10.1093/bja/aes474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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28
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Rossignol P, Boulu R, Ribart M, Paultre C, Bache S, Truelle B. [Action of some drugs used for cerebral vascular insufficiency on somesthesic primary potentials evoked at the level of cortex and thalamus in the cat in a state of acute cerebral ischemia]. C R Acad Hebd Seances Acad Sci D 1972; 274:3027-9. [PMID: 4626346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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