Effects of Tobacco Dose and Length of Exposure on Delayed Neurological Deterioration and Overall Clinical Outcome After Aneurysmal Subarachnoid Hemorrhage

Krishnamurthy, Satish; Kelleher, John; Lehman, Erik; Cockroft, Kevin M.

doi:10.1227/01.neu.0000290892.46954.12

Cited by 24 publications

(14 citation statements)

References 23 publications

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“…Thirty-three studies (63%) were rated as HQ. [9][10][11][12][13]15,16,[18][19][20]22,[28][29][30][31]35,36,38,39,[41][42][43]46,[48][49][50][51][52][53][54][55][56][57] Appendix 1 summarizes the study characteristics and the investigated variables. Altogether, 33 variables were reported.…”

Section: Resultsmentioning

confidence: 99%

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Rooij

Rinkel

Dankbaar

et al. 2013

Stroke

166

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Background and Purpose— Established predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage are large amounts of extravasated blood and poor clinical condition on admission. The predictive value of other factors is uncertain. Methods— We searched MEDLINE (1960–2012) for clinical, laboratory, and radiological predictors routinely available within 72 hours after subarachnoid hemorrhage. The studies were categorized according to methodological quality. Crude data and effect estimates (odds ratio [OR], hazard ratios, and risk ratio) with 95% CI were extracted, (re-)calculated and pooled if possible. For every potential predictor we assessed all effect estimates on consistency (point estimates in equal direction) and clinical relevance (size and 95% CI). Results— Fifty-two studies on 33 potential predictors were included. There was strong evidence (≥3 high-quality studies) for a higher risk of delayed cerebral ischemia in smokers (pooled OR, 1.2; 95% CI, 1.1–1.4), and moderate evidence (2 high-quality studies) for an increased risk in patients with hyperglycemia (OR, 3.2; 1.8–5.8 and hazard ratios, 1.7; 1.1–2.5), hydrocephalus (OR, 1.3; 1.1–1.5 and OR, 2.6; 1.2–5.5), history of diabetes mellitus (pooled OR, 6.7; 1.7–26), and early systemic inflammatory response syndrome (pooled OR, 2.1; 1.4–3.3). Evidence was limited for increased risk in women (pooled OR, 1.3; 1.1–1.6) and in patients with history of hypertension (pooled OR, 1.5; 1.3–1.7). The evidence on initial loss of consciousness, history of migraine, previous use of selective serotonin reuptake inhibitors, hypomagnesemia, low hemoglobin, or high blood flow on early transcranial Doppler was also limited. Conclusions— There is strong evidence that smoking is a predictor of delayed cerebral ischemia. For several other potential predictions the evidence is moderate, limited, or inconsistent.

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Section: Resultsmentioning

confidence: 99%

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Rooij

Rinkel

Dankbaar

et al. 2013

Stroke

166

View full text Add to dashboard Cite

show abstract

“…28 Case fatality remained fairly stable over time in this study, whereas others have suggested a decline over the past few decades. 7,29 Previous studies have found a higher risk of vasospasm and delayed ischemic neurologic deficit after aSAH among smokers, 30,31 and it has been suggested that immediate vasospasm may reduce the severity of the initial hemorrhage. Of these excluded patients, more were older than 70 years of age and died within 2 weeks during the 2 first time periods (1984 -1994) compared with after 1995.…”

Section: Resultsmentioning

confidence: 99%

Incidence and mortality of aneurysmal subarachnoid hemorrhage in two Norwegian cohorts, 1984–2007

et al. 2011

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“…For example, despite the fact that there were no differences in initial severity of illness (as measured by Hunt and Hess grade) between study groups, there was a significant reduction in the proportion of patients who were smokers between the two study groups (36.8% to 26.2%). Though smoking has been associated with the development of delayed ischemic deficits, it has not been shown to impact overall outcome following aneurysmal SAH [20]. In order to test the sensitivity of smoking and other risk factors on the finding in this study, it was re-estimated both univariate and multivariate regression models including only the risk factors (individually and as a group).…”

Section: Discussionmentioning

confidence: 99%