Effect of Early Brain Infarction After Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Gonçalves, Bruno; Turon, R; Mendes, Antenor; Melo, Nivea; Lacerda, Paula; Brasil, Pedro Emmanuel Alvarenga Americano do; Bozza, Fernando A.; Kurtz, Pedro; Righy, Cássia

doi:10.1016/j.wneu.2018.04.037

Cited by 20 publications

(14 citation statements)

References 25 publications

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“…Aneurysmal subarachnoid hemorrhage (SAH) is an acute cerebrovascular disease with devastating consequences, including high mortality and long-term functional impairment among survivors [1]. Several brain-specific mechanisms of injuries secondary to SAH have been associated with worse functional outcomes, including early injuries, vasospasms and delayed cerebral ischemia (DCI), neuroinflammation or impaired cerebral autoregulation [2–6]. However, there are few options for treating or preventing such complications of SAH.…”

Section: Introductionmentioning

confidence: 99%

Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study

Gonçalves

Kurtz

Turon

et al. 2019

Ann. Intensive Care

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Background Aneurysmal subarachnoid hemorrhage (SAH) is an acute cerebrovascular disease associated with high mortality and long-term functional impairment among survivors. Systemic inflammatory responses after acute injury and nosocomial infections are frequent complications, making the management of these patients challenging. Here, we hypothesized that sepsis might be associated with early and long-term mortality and functional outcomes. Our objective was to define the incidence of sepsis, diagnosed prospectively with the Sepsis-3 criteria, and to determine its impact on mortality and functional outcomes of patients with SAH. Methods We prospectively included all adult patients with aneurysmal SAH admitted to the intensive care unit (ICU) of a reference center between April 2016 and May 2018. Daily clinical and laboratory follow-up data were analyzed during the first 14 days, with data collected on sepsis according to the Sepsis-3 criteria. The main outcome was the functional outcome using the Modified Rankin Scale (mRS), which was assessed at hospital discharge and 3, 6 and 12 months post-discharge. Results In total, 149 patients were enrolled. The incidence of sepsis was 28%. Multivariable logistic regression analysis revealed that death or functional dependence (defined as an mRS score of 4 to 6) at hospital discharge was independently associated with sepsis (OR 3.4, 95% CI 1.16–9.96, p = 0.026) even after controlling for World Federation of Neurological Surgeons (WFNS) Scale (OR 4.66, 95% CI 1.69–12.88, p = 0.003), hydrocephalus (OR 4.55, 95% CI 1.61–12.85, p = 0.004) and DCI (OR 3.86, 95% CI 1.39–10.74, p = 0.01). Long-term follow-up mortality rates were significantly different in the septic and nonseptic groups (log-rank test p < 0.0001). The mortality rate of septic patients was 52.5%, and that of nonseptic patients was 16%. Conclusion Sepsis plays a significant role in the outcomes of patients with SAH, affecting both mortality and long-term functional outcomes. Combining high-level neurocritical care management of neurological complications and the optimal diagnosis and management of sepsis may effectively reduce secondary brain injury and improve patients’ outcomes after SAH.

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Section: Introductionmentioning

confidence: 99%

Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study

Gonçalves

Kurtz

Turon

et al. 2019

Ann. Intensive Care

Self Cite

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“…Arterial blood yet from the ruptured aneurysm wall tears and enters the adjacent brain tissue, forming a permanent brain cavity, filled with ICH clot. MRI (diffusion/perfusion/tractography) may give further prognostic information on brain edema [ 42 ], early brain ischemia [ 11 , 14 ], and injury to white matter tracts and nuclei, e.g., in relation to motor function [ 4 ] or impaired consciousness [ 20 ]. The local injury of the brain connectome is permanent; i.e., no axonal connections will redevelop across the ICH cavity that later in neuroimaging appears as a CSF cavity.…”

Section: Discussionmentioning

confidence: 99%

Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage

et al. 2021

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Background To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care. Methods Of the 769 consecutive aSAH patients from a defined population (2005–2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years. Results The 120 H&H 4–5 patients alive at 3 years form the final study population. On admission, 73% had H&H 4 but only 27% H&H 5, 59% intracerebral hematoma (ICH; median 22 cm3), and 26% intraventricular blood clot (IVH). The outcome was favorable (mRS 0–1) in 45% (54 patients: ICH 44%; IVH clot 31%; shunt 46%), moderate (mRS 2–3) in 30% (36 patients: ICH 64%; IVH clot 19%; shunt 42%), and unfavorable (mRS 4–5) in 25% (30 patients: ICH 80%; IVH clot 23%; shunt 50%). A total of 46% carried a ventriculoperitoneal shunt. ICH volume was a significant predictor of mRS at 3 years. Conclusions Of poor-grade aSAH patients, 45% were alive at 3 years, even 27% of those extending to pain (H&H 5). Of the survivors, 75% were at least in moderate condition, while only 2.6% ended in hospice care. Consequently, we propose non-selected admission to neurointensive care (1) for a possibility of moderate outcome, and (2), in case of brain death, possibly improved organ donation rates.

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“…The occurrence of cerebral infarction, one of the major diseases affecting the health of middle-aged and elderly people, is related to many factors [ 11 , 12 ]. The pathogenesis of cerebral infarction is mainly related to the metabolite level and vascular function in patients, and it is also affected by the expression of some genes or pathways [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Association Between Ghrelin Gene Polymorphism and Cerebral Infarction

et al. 2020

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Effect of Early Brain Infarction After Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 25 publications

Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study

Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study

Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage

Association Between Ghrelin Gene Polymorphism and Cerebral Infarction

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