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Wahjoepramono POP, Sasongko AB, Halim D, Aviani JK, Lukito PP, Adam A, Tsai YT, Wahjoepramono EJ, July J, Achmad TH. Hydrocephalus is an independent factor affecting morbidity and mortality of ICH patients: Systematic review and meta-analysis. World Neurosurg X 2023; 19:100194. [PMID: 37359762 PMCID: PMC10288487 DOI: 10.1016/j.wnsx.2023.100194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/04/2023] [Indexed: 06/28/2023] Open
Abstract
Background Despite advances in our knowledge of the causes, preventions, and treatments of stroke, it continues to be a leading cause of death and disability. The most common type of stroke-related morbidity and mortality is intracerebral haemorrhage (ICH). Many prognostication scores include an intraventricular extension (IVH) after ICH because it affects mortality independently. Although it is a direct result of IVH and results in significant damage, hydrocephalus (HC) has never been taken into account when calculating prognostication scores. This study aimed to evaluate the significance of hydrocephalus on the outcomes of ICH patients by meta-analysis. Methods Studies that compared the rates of mortality and/or morbidity in patients with ICH, ICH with IVH (ICH + IVH), and ICH with IVH and HC (ICH + IVH + HC) were identified. A meta-analysis was performed by using Mantel-Haezel Risk Ratio at 95% significance. Results This meta-analysis included thirteen studies. The findings indicate that ICH + IVH + HC has higher long-term (90-day) and short-term (30-day) mortality risks than ICH (4.26 and 2.30 higher risks, respectively) and ICH + IVH (1.96 and 1.54 higher risks). Patients with ICH + IVH + HC have lower rates of short-term (3 months) and long-term (6 months) good functional outcomes than those with ICH (0.66 and 0.38 times) or ICH + IVH (0.76 and 0.54 times). Confounding variables included vascular comorbidities, haemorrhage volume, midline shift, and an initial GCS score below 8. Conclusion Hydrocephalus causes a poorer prognosis in ICH patients. Thus, it is reasonable to suggest the inclusion of hydrocephalus in ICH prognostication scoring systems.
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Affiliation(s)
- Petra Octavian Perdana Wahjoepramono
- Department of Neurosurgery, Faculty of Medicine, Pelita Harapan University/Siloam Hospitals, Tangerang, Banten, Indonesia
- Post Graduate Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Aloysius Bagus Sasongko
- Department of Neurosurgery, Faculty of Medicine, Pelita Harapan University/Siloam Hospitals, Tangerang, Banten, Indonesia
- Post Graduate Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Danny Halim
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Jenifer Kiem Aviani
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Patrick Putra Lukito
- Department of Neurosurgery, Faculty of Medicine, Pelita Harapan University/Siloam Hospitals, Tangerang, Banten, Indonesia
| | - Achmad Adam
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Yeo Tseng Tsai
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Eka Julianta Wahjoepramono
- Department of Neurosurgery, Faculty of Medicine, Pelita Harapan University/Siloam Hospitals, Tangerang, Banten, Indonesia
| | - Julius July
- Department of Neurosurgery, Faculty of Medicine, Pelita Harapan University/Siloam Hospitals, Tangerang, Banten, Indonesia
| | - Tri Hanggono Achmad
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Basic Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Li Y, Zhang J, Wang H, Zhu L, Zhang H, Ma Q, Liu X, Dong L, Lu G. Does erythropoietin affect the outcome and complication rates of patient with traumatic brain injury? A pooled-analysis. Neurol Sci 2022; 43:3783-3793. [PMID: 35044560 DOI: 10.1007/s10072-022-05877-4] [Citation(s) in RCA: 4] [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: 05/31/2021] [Accepted: 01/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this meta-analysis was to review the scientific literature published until April 18, 2021, to summarize existing knowledge on the efficacy and safety of erythropoietin (EPO) for traumatic brain injury (TBI). METHODS This systematic review followed PRISMA guidelines. Randomized controlled trials (RCTs) reporting on the efficacy and safety of EPO in the treatment of TBI were systematically searched in relevant electronic databases according to a pre-designed search strategy. The primary outcomes are the mortality; and secondary outcomes are the good functional outcome (GFO) and adverse events (AEs). RESULTS A total of 10 RCTs involving 2,402 participants fulfilled the inclusion criteria. The results showed that there is a significant difference in terms of the mortality (RR = 0.67, 95% CI = 0.54-0.84, P = 0.0003) and seizure rate (RR = 0.52, 95% CI = 0.29-0.96, P = 0.04) between the EPO groups compared to those in the control groups. However, compared with the control groups, the GFO in the EPO groups was not statistically significant (RR = 1.18, 95% CI = 0.93-1.48, P = 0.17). CONCLUSIONS Findings of the present meta-analysis suggest that the use of EPO could reduce mortality rate in patients with TBI, without increasing the incidence of AEs. EPO has potential research and application value in the treatment of TBI.
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Affiliation(s)
- Yuping Li
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China.,Department of Neurosurgery, Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Jun Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Haili Wang
- Department of Clinical Medicine, Dalian Medical University, Dalian Liaoning, China
| | - Lei Zhu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Qiang Ma
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaoguang Liu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Lun Dong
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China.,Department of Neurosurgery, Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Guangyu Lu
- Institute of Public Health, Medical College, Yangzhou University, Yangzhou, China.
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Yang WY, Li YF, Wang ZR, Yu TX, Xu DJ, Yang N, Niu XY, Cai XL, Zhuo WY, Wu XM, Yan M, Zhou JS, Zhang HW, Liang ZG, Wu WJ, Cheng JH, Huang LA, Zhang YS, Guan Y, Tan ZF, Lu D, He N, Dong DW, Zhu HL, Yang B, Shen QY, Xu AD. Combined therapy of intensive statin plus intravenous rt-PA in acute ischemic stroke: the INSPIRE randomized clinical trial. J Neurol 2021; 268:2560-2569. [PMID: 33555418 DOI: 10.1007/s00415-020-10388-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/31/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of intensive statin in the acute phase of ischemic stroke after intravenous thrombolysis therapy. METHODS A total of 310 stroke patients treated with rt-PA were randomly scheduled into the intensive statin group (rosuvastatin 20 mg daily × 14 days) and the control group (rosuvastatin 5 mg daily × 14 days). The primary clinical endpoint was excellent functional outcome (mRS ≤ 1) at 3 months, and the primary safety endpoint was symptomatic intracranial hemorrhage (sICH) in 90 days. RESULTS The intensive statin users did not achieve a favorable outcome in excellent functional outcome (mRS ≤ 1) at 3 months compared with controls (70.3% vs. 66.5%, p = 0.464). Intensive statin also not significantly improved the overall distribution of scores on the modified Rankin scale, as compared with controls (p = 0.82 by the Cochran-Mantel-Haenszel test). The incidence of primary safety endpoint events (sICH) in 90 days did not significantly differ between the intensive statin group and control group (0.6% vs. 1.3%, p > 0.999). CONCLUSION The INSPIRE study indicated that intensive statin therapy may not improve clinical outcomes compared with the low dose of statin therapy in AIS patients undergoing intravenous thrombolysis, and the two groups had similar safety profile. CLINICAL TRIAL REGISTRATION URL: http://www.chictr.org . Unique identifier: ChiCTR-IPR-16008642.
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Affiliation(s)
- Wan-Yong Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Yu-Feng Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Zi-Ran Wang
- Department of Neurology and Stroke Center, Linyi People's Hospital, Linyi, 276003, China
| | - Tian-Xia Yu
- Department of Neurology, Yan Tai Shan Hospital, Yantai, 264000, China
| | - Dong-Juan Xu
- Department of Neurology, Dongyang Affiliated Hospital of Wenzhou Medical University, Dongyang, 322100, China
| | - Nan Yang
- Department of Neurology, Traditional Chinese Medicine Hospital of Zhongshan City, Zhongshan, 528400, China
| | - Xiao-Yuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, 030000, China
| | - Xue-Li Cai
- Department of Neurology, Lishui Hospital of Zhejiang University, The Central Hospital of Lishui, Lishui, 323000, China
| | - Wen-Yan Zhuo
- Department of Neurology, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000, China
| | - Xue-Mei Wu
- Department of Neurology, General Hospital of TISCO, Taiyuan, 030000, China
| | - Min Yan
- Jingdong Medical District, General Hospital of the Chinese People's Liberation Army, Beijing, 100853, China
| | - Jun-Shan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210000, China
| | - Hao-Wen Zhang
- Department of Neurology, Laixi City People's Hospital, Qingdao, 266600, China
| | - Zhi-Gang Liang
- Department of Neurology, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, 264000, China
| | - Wen-Jun Wu
- Department of Neurology, Zhongshan City People's Hospital, Zhongshan, 528403, China
| | - Jian-Hua Cheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Li-An Huang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Yu-Sheng Zhang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Ying Guan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Ze-Feng Tan
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Dan Lu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Niu He
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Da-Wei Dong
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Hui-Li Zhu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Bing Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Qing-Yu Shen
- Department of Neurology, Sun-Yet Sen Memorial Hospital of Sun-Yet Sen University, Guangzhou, 510120, China.
| | - An-Ding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China. .,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.
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Zhang J, Wang H, Li Y, Zhang H, Dong L. The efficacy of progesterone 1 mg kg -1 every 12 hours over 5 days in moderate-to-severe traumatic brain injury: A meta-analysis of randomized controlled trials. Clin Neurol Neurosurg 2020; 198:106131. [PMID: 32823183 DOI: 10.1016/j.clineuro.2020.106131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/14/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this meta-analysis was to assess the efficacy of progesterone (PG) at 1.0 mg kg-1 once every 12 h for 5 consecutive days in patients with moderate-to-severe (Glasgow Coma Score [GCS] 3-12) traumatic brain injury (TBI). METHODS The Cochrane Library, OvidSP, Web of Science, PubMed, CNKI, WFSD, and VIP databases were systematically searched from inception to May 1, 2020. The quality of included studies was evaluated using the bias risk assessment tool from the Cochrane systematic evaluator manual 5.1.0. A pooled analysis of relevant data was conducted using RevMan 5.3 software. The primary outcome was good functional outcome (GFO), and the secondary outcome was mortality. Subgroup analysis was performed to explore the impact of time, administration route, type of injury, and GCS on outcome measures. RESULTS A total of 7 randomized controlled trials involving 504 participants were included in this meta-analysis. The findings indicated a statistically significant difference in terms of GFO (RR, 1.48; 95 % confidence interval [CI], 1.25-1.76; P < 0.00001) and mortality (RR, 0.66; 95 % CI, 0.44-0.84; P = 0.002) between the PG and control groups. Subgroup analyses demonstrated that administration route was an important influencing factor for improving GFO in the PG group, and administration route and follow-up time were important for reducing mortality in the PG group. CONCLUSIONS We conclude that PG, at a dose of 1.0 mg kg-1 via intramuscular injection every 12 h for 5 consecutive days, could significantly improve GFO (1 month, 3 months, 6 months, and 12 months) and reduce the medium-term (3-month and 6-month) mortality rate. Larger studies are needed to support our findings.
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Affiliation(s)
- Jun Zhang
- Department of Clinical Medicine, Dalian Medical University, Dalian Liaoning, China
| | - Haili Wang
- Department of Clinical Medicine, Dalian Medical University, Dalian Liaoning, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lun Dong
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China.
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