Healthcare Economics of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage in the United States

Adil, Syed M; Liu, Beiyu; Charalambous, Lefko T; Kiyani, Musa; Gramer, Robert; Swisher, Christa B.; Verbick, Laura Zitella; McCabe, Aaron; Parente, Beth; Pagadala, Promila; Lad, Shivanand P.

doi:10.1007/s12975-019-00697-9

Cited by 21 publications

(11 citation statements)

References 21 publications

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“…SAH has been identified as a devastating subtype of hemorrhagic stroke with high mortality and disability ( 29 ). Despite advancements in the treatment and management of SAH patients, the prognosis is still extremely poor ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2021

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The neutrophil–to-lymphocyte ratio (NLR), as an essential systemic inflammation factor, has been widely used as a prognostic indicator in various diseases, such as malignant tumors, cardiovascular disease, and intracranial hemorrhage. An increasing number of studies have believed that NLR is a valuable predictor of prognosis for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, these results remain controversial. In the current study, we planned to carry out a systematic review and meta-analysis to investigate the association between NLR and poor outcome, and the occurrence of delayed cerebral ischemia (DCI). We carried out a comprehensive search for published literatures on PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to April 1, 2021. We conducted an assessment of all included studies based on the principles proposed in the Newcastle-Ottawa Quality Assessment Scale (NOS). Poor outcome and the occurrence of DCI were considered as the main outcome measure. We calculated the pooled odds ratio (OR) and corresponding 95% confidence interval (CI) to examine the strength of the association of NLR with poor outcome or the occurrence of DCI. We strictly selected a total of 10 studies comprising 4,989 patients. Nine studies reported the association between NLR and poor outcome, and five studies reported the association between NLR and the occurrence of DCI. The pooled results indicated higher NLR was significantly associated with both poorer outcomes (OR = 1.32, 95%CI 1.11–1.57; P = 0.002, I2 = 87%), and the occurrence of DCI (OR = 1.72, 95%CI 1.22–2.41; P = 0.002, I2 = 82%) in aSAH patients. The NLR is a valuable indicator of inflammation to independently predict poor outcome and occurrence of DCI after aSAH, where a higher NLR is significantly associated with poor outcomes and occurrence of DCI. These findings suggest that the NLR can help clinicians evaluate the prognosis and identify potentially severe patients early, which may contribute to better management and improve poor prognosis of aSAH patients.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2021

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“…Hydrocephalus is one of the most common complications and reasons for readmission after SAH; according to previous reports, hydrocephalus was diagnosed in 40.4% in aneurysmal SAH patients undergoing surgical clipping or endovascular coiling [140,141]. About 44-63% of rats develop hydrocephalus after experimental SAH induced by vascular perforation [134,142].…”

Section: Thrombin In Subarachnoid Hemorrhagementioning

confidence: 99%

The Role of Thrombin in Brain Injury After Hemorrhagic and Ischemic Stroke

Garton

Hua

et al. 2020

Transl. Stroke Res.

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Thrombin is increased in the brain after hemorrhagic and ischemic stroke primarily due to the prothrombin entry from blood either with a hemorrhage or following blood-brain barrier disruption. Increasing evidence indicates that thrombin and its receptors (protease-activated receptors (PARs)) play a major role in brain pathology following ischemic and hemorrhagic stroke (including intracerebral, intraventricular, and subarachnoid hemorrhage). Thrombin and PARs affect brain injury via multiple mechanisms that can be detrimental or protective. The cleavage of prothrombin into thrombin is the key step of hemostasis and thrombosis which takes place in every stroke and subsequent brain injury. The extravascular effects and direct cellular interactions of thrombin are mediated by PARs (PAR-1, PAR-3, and PAR-4) and their downstream signaling in multiple brain cell types. Such effects include inducing blood-brain-barrier disruption, brain edema, neuroinflammation, and neuronal death, although low thrombin concentrations can promote cell survival. Also, thrombin directly links the coagulation system to the immune system by activating interleukin-1α. Such effects of thrombin can result in both short-term brain injury and longterm functional deficits, making extravascular thrombin an understudied therapeutic target for stroke. This review examines the role of thrombin and PARs in brain injury following hemorrhagic and ischemic stroke and the potential treatment strategies which are complicated by their role in both hemostasis and brain.

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“…If the serum glucose was measured multiple times in one day, the median measurement would be used for that daily value. Moreover, SAH-related complications, such as rebleeding, acute hydrocephalus, seizure, and DCI were also reviewed [19][20][21].…”

Section: Patient Managementmentioning

confidence: 99%

Serum glucose as an important predictor of delayed cerebral ischemia in angiogram-negative subarachnoid hemorrhage

Zhang

Wang

et al. 2021

Preprint

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Background Despite benign overall course, angiogram-negative subarachnoid hemorrhage (AN-SAH) still companies with risk of delayed cerebral ischemia (DCI). Serum glucose was previously found to be related to DCI occurrence in aneurysmal subarachnoid hemorrhage (aSAH), but this has not been confirmed in AN-SAH. The aim of this study was to clarify the significance of serum glucose in DCI prediction in AN-SAH patients. Methods We included patients with AN-SAH admitted to our hospital between January 2013 and December 2018. According to different bleeding patterns, patients were divided into perimesencephalic AN-SAH (PAN-SAH) and non-perimesencephalic AN-SAH (NPAH-SAH) patients. DCI was defined as symptomatic vasospasm or/and delayed cerebral infarction. A statistical analysis of the clinical, radiological, and laboratory risk factors of DCI was conducted. Logistic regression analysis was performed to identify the independent predictors of DCI. Results A total of 244 AN-SAH patients (mean age 55.7 years, 55.7% men) were included with 164 (67.2%) PAN-SAH patients and 80 (32.8%) NPAN-SAH patients. There were significant correlations between high DCI incidence and high serum glucose levels in the first five days after admission in both PAN-SAH patients and NPAN-SAH patients (p < 0.05). High admission serum glucose was significantly related to higher World Federation of Neurosurgeons Scale (WFNS) (p < 0.05). Multivariate logistic regression analysis showed that admission serum glucose (p = 0.001, OR 1.705, 95% CI 1.232–2.360) and WFNS (p = 0.008, OR 2.889, 95% CI 1.322–6.311) were both significant and independent predictors for DCI occurrence in PAN-SAH patients. Admission serum glucose (p = 0.016, OR 2.307, 95% CI 1.167–4.562), standard deviation (SD) of the serum glucose in the first three days after admission (p = 0.049, OR 5.684, 95% CI 1.006–32.114) and modified Fisher scale (mFS) (p = 0.033, OR 1.859, 95% CI 1.051–3.288) were significant and independent predictors for DCI occurrence in NPAN-SAH patients. Conclusions Serum glucose is an early biomarker to predict DCI risk in both PAN-SAH and NPAN-SAH patients, which has an important value in guiding intensive care in AN-SAH patients.

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Healthcare Economics of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage in the United States

Cited by 21 publications

References 21 publications

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies

The Role of Thrombin in Brain Injury After Hemorrhagic and Ischemic Stroke

Serum glucose as an important predictor of delayed cerebral ischemia in angiogram-negative subarachnoid hemorrhage

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