Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury

Haupenthal, David; Kuramatsu, Joji B.; Volbers, Bastian; Sembill, Jochen A.; Mrochen, Anne; Balk, Stefanie; Hoelter, Philip; Lücking, Hannes; Engelhorn, Tobias; Dörfler, Arnd; Schwab, Stefan; Huttner, Hagen B.; Sprügel, Maximilian I.

doi:10.1001/jamanetworkopen.2021.15859

Cited by 17 publications

(18 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, the purpose of emergent/urgent surgery is to reduce the associated complications of hematoma [ 10 , 11 ]. Unfortunately, despite current standard method employed, disability is still unacceptably high in hemorrhagic stroke survivors that is serious enough to decrease their employability and social activity [ 12 ]. Of importance is that not every victim of hemorrhagic stroke is suitable for or beneficial from surgical intervention in clinical practice [ 13 ], suggesting the treatment of hemorrhagic stroke is unmet need.…”

Section: Introductionmentioning

confidence: 99%

Dose-dependent benefits of iron-magnetic nanoparticle-coated human umbilical-derived mesenchymal stem cell treatment in rat intracranial hemorrhage model

et al. 2022

View full text Add to dashboard Cite

Background This study tested whether two doses of human umbilical-derived mesenchymal stem cells (hUC-MSCs) were superior to one dose for protecting the brain against intracranial hemorrhage (ICH) induced by intracranial injection collagenase and the capacity of ironic-magnetic-nanoparticles (Ir-MNa) coated hUC-MSCs tracked by MRI. Methods and results Adult male SD rats (n = 40) were equally categorized into group 1 (sham-operated-control), group 2 (ICH), group 3 [ICH + Ir-MNa-coated hUC-MSCs/1.2 × 106 cells with an extracorporeal magnet over rat head (eCMag)/administered by left internal carotid artery (LICA) at post-3 h ICH], and group 4 (ICH + Ir-MNa-coated hUC-MSCs/1.2 × 106 cells with an eCMag/administered post-3 h ICH by LICA and 24 h by IV) and euthanized by day 28. The result showed that by day 28 after ICH induction the neurological function was severely impaired in group 2 than in group 1 that was significantly improved in group 3 and further significantly improved in group 4, whereas ICH volume exhibited an opposite pattern of neurological impairment among the groups (all p < 0.0001). Brain MRI demonstrated that by 4 h after ICH, Ir-MNa-coated hUC-MSCs were abundantly identified in ischemic area in group 4. The protein expressions of inflammatory (TNF-α/MMP-9/IL-1ß/iNOS)/oxidative-stress (NOX-1/NOX-2/oxidized protein)/apoptotic (caspase-3/mitochondrial Bax/PARP)/fibrotic (Smad3/TGF-ß)/mitochondrial-damaged (cytosolic-cytochrome-C) biomarkers displayed an identical pattern of neurological impairment among the groups (all p < 0.0001). The cellular expressions of inflammation (CD68+/CD11b+)/brain edema (AQP4+) biomarkers exhibited an identical pattern, whereas the neuronal-myelin (Doublecortin+/NeuN/nestin) biomarkers displayed an opposite pattern of neurological impairment (all p < 0.0001). Conclusion Two doses of hUC-MSCs were superior to just one dose for protecting the brain against ICH-induced damage and Ir-MNa-coated hUC-MSCs offered a well adopted method for tracking hUC-MSCs homing into the brain.

show abstract

Section: Introductionmentioning

confidence: 99%

Dose-dependent benefits of iron-magnetic nanoparticle-coated human umbilical-derived mesenchymal stem cell treatment in rat intracranial hemorrhage model

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Although Glance et al in a study involving over 316,000 surgical patients demonstrated that thrombocytopenia found during routine preoperative testing was associated with a higher risk of transfusion and death [ 13 ], PLT count was not a useful predictive parameter of death in our study. Although performing routine coagulation tests before surgery has been shown to have no advantage over information from the patient’s medical history and physical examination [ 14 ], bleeding into the central nervous system structures is a strong risk factor for disability and an exponent of adverse neurological prognosis [ 15 ]. Limiting laboratory testing in neurosurgery to patients with significant medical history would save an estimated value of more than USD 80M each year [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Platelet-Derived Parameters in Prognostication in Neurosurgery

Pluta

Dziech

Klocek

et al. 2022

IJERPH

View full text Add to dashboard Cite

Introduction. Platelets (PLT) are key mediators in thrombotic and inflammatory processes. Their activity increases with size, so the mean platelet volume (MPV) can be a potential predictor of perioperative complications. The aim of the study was to assess the suitability of platelet parameters in predicting the risk of hospital death in neurosurgery. Methods. Retrospective observation covered 452 patients undergoing surgery in the period March 2018–August 2018. High-risk patients accounted for 44% (i.e., ASA-PS class III+) and 9% (i.e., ≥1 Shoemaker criterion), respectively, and 14% of procedures were performed in the urgent mode. The preoperative platelet parameters that were assessed and analysed were: total platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW). The end point of the study was a hospital death. Results. Before discharge from the hospital, 13 patients died. The medians (IQR) PLT, MPV PDW and PCT were, respectively: 230 × 106 L−1 (182–279); 9.2 fL (8.3–10.1); 14% (12.5–16.3); and 21% (17–26). PLT, PCT and PDW were not useful in the risk assessment. MPV was lower in patients who died (9.3 vs. 8.3 fL, p < 0.01) and predicted death occurred in 76% (AUC = 0.76, 95%CI 0.72–0.80, p < 0.01). Further, after adjustment for confounders, MPV remained a significant predictor of in-hospital death (logOR[MPV] = 0.31, AUC = 0.94, 95%CI 0.92–0.96, p = 0.02). Conclusion. The reduction in the average volume of platelets is associated with a worse prognosis in neurosurgical patients.

show abstract

“…Subgroup analyses were conducted for the primary outcome among the subgroups of patients according to age (≤70 years >70 years), sex (women, men), type of disease (IS, ICH, SAH, CABM, SE), timing of treatment initiation (early, delayed, late), treatment dosage (≤300 mg, >300 mg) and GCS at hospital admission. [3][4][5][6][7][8][9][10][11][12][13][14][15] For exploratory analyses, the time course of GCS values before and after initiation of amantadine treatment was compared between treatment and control group.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…1 2 Rehabilitation should be initiated early after brain injury to ensure recovery and prevent long-term disability. [3][4][5] However, patients with severe brain injury frequently suffer from impaired consciousness undermining rehabilitation and functional recovery. 3 6 Moreover, prolonged impairment of consciousness may result in unjustified care limitation and worse patient outcome by selffulfilling prophecy.…”

Section: Introductionmentioning

confidence: 99%

“…Globally, there are approximately 55 million people living with disability related to traumatic brain injury (TBI) and 80 million with disability related to stroke 1 2. Rehabilitation should be initiated early after brain injury to ensure recovery and prevent long-term disability 3–5. However, patients with severe brain injury frequently suffer from impaired consciousness undermining rehabilitation and functional recovery 3 6.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury

Rühl

Kuramatsu

Sembill

et al. 2022

J Neurol Neurosurg Psychiatry

Self Cite

View full text Add to dashboard Cite

ObjectiveThis study determined the effect of amantadine treatment on consciousness in patients with non-traumatic brain injury.MethodsWe pooled individual patient data of five single-centre observational studies to determine the effect of amantadine treatment among patients with ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, community-acquired bacterial meningitis and status epilepticus, admitted between January 2012 and December 2015 and ventilated ≥7 days. Patient selection and multivariable regression modelling were used to adjust for differences in intergroup comparison and for parameters associated with consciousness. Improvement of consciousness 5 days after treatment initiation was defined as primary outcome. Secondary outcomes included Glasgow Coma Scale (GCS) at day 5 and GCS at day 10, rate of ICU delirium, epileptic seizures and all-cause mortality at 90 days.ResultsOverall, 84 of 294 (28.6%) eligible patients received amantadine. Amantadine treatment was associated with improvement of consciousness at day 5 (amantadine: 86.9% vs control: 54.0%; absolute difference: 32.9 (20.0–44.2); adjusted OR (aOR): 5.71 (2.50–13.05), p<0.001). Secondary outcomes showed differences in GCS 5 days (9 (8–11) vs 6 (3–9), p<0.001) and GCS 10 days (10(8–11) vs 9(6–11),p=0.003) after treatment initiation. There were no significant differences regarding all-cause mortality (aOR: 0.89 (0.44–1.82), p=0.758) and ICU delirium (aOR: 1.39 (0.58–3.31), p=0.462). Rate of epileptic seizures after initiation of amantadine treatment was numerically higher in the amantadine group (amantadine: 10.7% vs control: 3.0%; absolute difference: 7.7 (0.3–16.4); aOR: 3.68 (0.86–15.71), p=0.079).ConclusionsAmantadine treatment is associated with improved consciousness among patients with different types of non-traumatic brain injury in this observational cohort analysis. Epileptic seizures should be considered as potential side effects and randomised controlled trials are needed to confirm these findings.

show abstract

Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury

Abstract: IMPORTANCE Intracerebral hemorrhage (ICH) contributes significantly to the global burden of disease. OBJECTIVE To examine the association of ICH and secondary injury with disability-adjusted lifeyears (DALYs) for the individual patient.

Cited by 17 publications

References 44 publications

Dose-dependent benefits of iron-magnetic nanoparticle-coated human umbilical-derived mesenchymal stem cell treatment in rat intracranial hemorrhage model

Dose-dependent benefits of iron-magnetic nanoparticle-coated human umbilical-derived mesenchymal stem cell treatment in rat intracranial hemorrhage model

Diagnostic Accuracy of Platelet-Derived Parameters in Prognostication in Neurosurgery

Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury

Contact Info

Product

Resources

About