Epidemiology of Subarachnoid Hemorrhage, Patterns of Management, and Outcomes in China: A Hospital‐Based Multicenter Prospective Study

Bian, Liheng; Liu, Yanfang; Nichols, Li Tan; Wang, Chunxue; Wang, Yilong; Liu, Gaifen; Wang, Wenjuan; Wang, Wenjuan

doi:10.1111/cns.12001

Cited by 27 publications

(28 citation statements)

References 20 publications

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“…In the past 30 years, mortality associated with aSAH has shown a downward trend in China [9], probably due to improved diagnostic techniques, early aneurysm repair, and intensive medical management. However, data from the CNSR showed that mortality was still high at 28 days, 3, 6, and 12 months, that is, 16.9, 21.2, 23.6, and 24.6%, respectively, for patients with aSAH [8]. Furthermore, we found that 34% of patients with aSAH who survive will not regain full independence, and about 70% will have impaired quality of life.…”

Section: Discussionmentioning

confidence: 82%

“…Most of the studies used to determine risk factors to date are limited by either being single-center series, including a predominance of patients treated by open micro-neurosurgery, or using a selected patient group randomized to clinical trials [7]. Furthermore, advances in diagnostic and treatment strategies for aSAH have substantially improved the outcomes of patients over the last decade(s); however, previous studies on the epidemiology of stroke in China showed that the mortality and disability after aSAH were still relatively high, leading to a huge burden on individuals, families, and society [8, 9]. Nevertheless, limited studies provide data on clinical characteristics, risk factors, and clinical outcomes of DCI after aSAH in China.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry

et al. 2018

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Background: Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is a significant cause of morbidity and mortality. While it is important to detect early signs of DCI, patients with high risk of DCI are difficult to identify, and the potential risk factors are uncertain. This study aimed to identify independent risk factors of DCI and clarify their clinical impact on outcome and the disease course. Methods: For this nationwide, multicenter, prospective clinical study involving consecutive patients with aSAH recruited from the China National Stroke Registry, demographic, clinical, radiological, and laboratorial data during hospitalisation, in-hospital complications, functional outcomes, and mortality at 3, 6, and 12 months were recorded. Using univariate and multivariate logistic regression to determine risk factors associated with the development of DCI, the contribution of DCI to short- and long-term outcomes was evaluated. Results: Of all 504 patients with aSAH, 155 developed DCI. Multivariate analysis revealed that being female, a history of diabetes mellitus, a Hunt and Hess grade of 4–5, and a World Federation of Neurosurgical Societies grade of IV–V were independent risk factors of DCI. DCI was associated with high in-hospital complications, and with a high utilization rate of supporting interventions. DCI also contributed to poorer functional outcome and higher mortality at discharge and after 3, 6, and 12 months. Conclusions: Female sex, a history of diabetes mellitus, and poor clinical grade are independent early risk factors for the development of DCI and can contribute to a better identification of patients at a high risk for DCI. DCI was associated with severe clinical course, poor outcome, and mortality both in the short- and long-term in patients with aSAH in China.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry

et al. 2018

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“…[9101112] The development of both diagnostic modalities and emergent rescuing capabilities is the most important contributor to this discrepancy. This study is based on nationwide data collected from 32 major neurosurgical centers and represents the largest hospital-based epidemiological analysis of SAH in China.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Features of Nontraumatic Spontaneous Subarachnoid Hemorrhage in China

Song

et al. 2017

Chinese Medical Journal

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Background:Nontraumatic spontaneous subarachnoid hemorrhage (SAH) is associated with a high mortality. This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.Methods:From January 2006 to December 2008, the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated. Emergent digital subtraction angiography (DSA) was performed for the diagnosis of SAH sources in the acute stage of SAH (≤3 days). The results and complications of emergent DSA were analyzed. Repeated DSA or computed tomography angiography (CTA) was suggested 2 weeks later if initial angiographic result was negative.Results:A total of 2562 patients were enrolled, including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH. The total complication rate of emergent DSA was 3.9% without any mortality. Among the patients with aneurysmal SAH, 321 cases (15.4%) had multiple aneurysms, and a total of 2435 aneurysms were detected. The aneurysms mostly originated from the anterior communicating artery (30.1%), posterior communicating artery (28.7%), and middle cerebral artery (15.9%). Among the nonaneurysmal SAH cases, 76.5% (n = 365) had negative initial DSA, including 62 cases with peri-mesencephalic nonaneurysmal SAH (PNSAH). Repeated DSA or CTA was performed in 252 patients with negative initial DSA, including 45 PNSAH cases. Among them, the repeated angiographic results remained negative in 45 PNSAH cases, but 28 (13.5%) intracranial aneurysms were detected in the remaining 207 cases. In addition, brain arteriovenous malformation (AVM, 7.5%), Moyamoya disease (7.3%), stenosis or sclerosis of the cerebral artery (2.7%), and dural arteriovenous fistula or carotid cavernous fistula (2.3%) were the major causes of nonaneurysmal SAH.Conclusions:DSA can be performed safely for pathological diagnosis in the acute stage of SAH. Ruptured intracranial aneurysms, AVM, and Moyamoya disease are the major causes of SAH detected by emergent DSA in China.

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“…An 18-point system was used to assess animals' neurological deficits from six aspects, including spontaneous activity (0-3), symmetry movements of all limbs (0-3), outstretching of forelimbs (0-3), climbing (1-3), body proprioception (1-3), and response to vibrissae touch (1)(2)(3). A minimum score is at least 3 and a maximum score is 18.…”

Section: Assessment Of Neurological Score and Beam Balancementioning

confidence: 99%

“…By mainly affecting middle-aged patients and a highest fatality in all stroke subtypes, SAH brings about a huge burden on economy and society [1][2][3]. Plenty of researches have focused on the cerebral vasospasm, which was traditionally deemed as the principal cause of poor prognosis in SAH patients [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Hydrogen-Rich Saline Attenuated Subarachnoid Hemorrhage-Induced Early Brain Injury in Rats by Suppressing Inflammatory Response: Possible Involvement of NF-κB Pathway and NLRP3 Inflammasome

et al. 2015

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Early brain injury (EBI), highlighted with inflammation and apoptosis, occurring within 72 h after subarachnoid hemorrhage (SAH), is associated with the prognosis of SAH. Recent studies have revealed that hydrogen-rich saline (HS) exerted multiple neuroprotective properties in many neurological diseases including SAH, involved to anti-oxidative and anti-apoptotic effect. We have previously reported that HS could attenuate neuronal apoptosis as well as vasospasm. However, the underlying mechanism of HS on inflammation in SAH-induced EBI remains unclear. In this study, we explored the influence of HS on nuclear factor-κB (NF-κB) pathway and nucleotide binding and oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome at early stage after SAH, by injecting HS intraperitoneally to SAH rats. One hundred and twenty-nine SD rats were randomly divided into four groups: sham group, SAH group, SAH+vehicle group, and SAH+HS group. SAH model was conducted using endovascular perforation method; all rats were sacrificed at 24 h after SAH. Protein level of pIκBα, cytosolic and nuclear p65, NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), caspase-1, interleukin-1β (IL-1β), and cleaved caspase-3 were measured by western blot. mRNA level of IL-1β, interleukin-6 (IL-6), tumor necrosis factor-c (TNF-α) were evaluated by RT-PCR. Cellular injury and death was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Nissl staining, respectively. Our results showed that pIκBα, nuclear p65, NLRP3, ASC, caspase-1, IL-1β, cleaved caspase-3 proteins, as well as the mRNA of IL-1β, IL-6, and TNF-ɑ increased at 24 h after SAH, while cytosolic p65 decreased. TUNEL and Nissl staining presented severe cellular injury at 24 h post-SAH. However, after HS administration, the changes mentioned above were reversed. In conclusion, HS may inhibit inflammation in EBI and improve neurobehavioral outcome after SAH, partially via inactivation of NF-κB pathway and NLRP3 inflammasome. Graphical Abstract Schematic representation of the mechanism of HS-mediated anti-inflammatory effect in EBI after SAH. The NF-κB inflammatory pathway and NLRP3 inflammasome are involved in the anti-neuroinflammatory effect of HS post-SAH. SAH-induced oxidative stress enhances the activation of NF-κB, thus promoting the translocation of p65 subunit into nucleus and increasing the mRNA level of its downstream proinflammatory cytokines (IL-1β, IN-6, TNF-α) and NLRP3. Elevated expression of NLRP3 mRNA increases the assembly of NLRP3 inflammasome. In addition, oxidative stress after SAH stimulates the activation of NLRP3 inflammasome, therefore, promoting caspase-1 activation and the cleavage of pro-IL-1β into mature IL-1β. Finally, activation of NF-κB pathway and NLRP3 inflammasome contribute to the inflammation response and cellular injury in EBI after SAH. HS treatment reversed the detrimental effect mentioned above via inactivation of NF-κB pathway and NLRP3 inflammasome. ...

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Epidemiology of Subarachnoid Hemorrhage, Patterns of Management, and Outcomes in China: A Hospital‐Based Multicenter Prospective Study

Cited by 27 publications

References 20 publications

Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry

Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry

Epidemiological Features of Nontraumatic Spontaneous Subarachnoid Hemorrhage in China

Hydrogen-Rich Saline Attenuated Subarachnoid Hemorrhage-Induced Early Brain Injury in Rats by Suppressing Inflammatory Response: Possible Involvement of NF-κB Pathway and NLRP3 Inflammasome

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