Elevated blood urea nitrogen is associated with recurrence of post-operative chronic subdural hematoma

Wang, Ning; Hu, Jiangnan; Oppong-Gyebi, Anthony; Zhu, Xuanhao; Li, Yihao; Yang, Jianjing; Ruan, Linhui; Zhuge, Qichuan; Ye, Sheng

doi:10.1186/s12883-020-01985-w

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…This study indicated associations between elevated activated partial thromboplastin time (APTT), prothrombin time (PT) and international normalized ratio (INR) and worse outcome [17]. Reduced levels of serum fibrinogen in cases manifesting recurrence of cSDH compared with non-recurrence cases were indicated in the univariate analysis conducted by Wang et al [25].…”

Section: Cytokinesmentioning

confidence: 82%

Section: Other/miscellaneousmentioning

confidence: 99%

“…In the largest prospective cohort study identified (653 patients), blood urea nitrogen (BUN) levels and additional variables (PLTs, fibrinogen, leukocytes, erythrocytes, hemoglobin, creatinine) were analyzed [25]. The authors indicated that elevated postoperative BUN levels (> 6.4 mmol/L) was the only measure independently associated with cSDH recurrence [25]. In a second prospective cohort study on 119 patients, Chihi et al showed that the preoperative plasma brain natriuretic peptide (BNP-1) level on admission is an independent predictor of poor functional outcome at the 5-to 6-month follow-up [28].…”

Section: Other/miscellaneousmentioning

confidence: 99%

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Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

Georgountzos,

Gkalonakis,

Anastasopoulos

et al. 2023

Diagnostics

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The present systematic scoping review aimed at mapping and analyzing the available literature on biological fluid (biofluid) biomarkers showing promise in the prediction of chronic subdural hematoma (cSDH) recurrence and the prognosis of neurological/functional patient outcome. Twenty-three studies published between 2003 and 2023 investigating a diverse range of biomarkers in hematoma fluid and/or the circulation in 3749 patients were included. Immune cell populations and inflammatory/anti-inflammatory cytokines comprised the most studied category of biomarkers displaying significant findings. A notable time trend in biomarker studies was a recent shift in research focus towards the analysis of circulating biomarkers. Several biomarkers were indicated as independent predictors of cSDH recurrence and/or functional/neurological outcome, including circulating fibrinogen degradation products (FDP), brain natriuretic peptide (BNP-1) and high-density lipoprotein (HDL), as well as blood urea nitrogen (BUN) and the ratios of blood neutrophil to lymphocyte (NLR) or red blood cell distribution width to platelet count (RPR). While studies on cSDH prognostic biomarkers have gained, in recent years, momentum, additional multicenter prospective studies are warranted to confirm and extend their findings. The identification of prognostic biofluid biomarkers in cSDH is an active field of research that may provide future tools, guiding clinical decisions and allowing for the design of treatments based on risk stratification.

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Section: Cytokinesmentioning

confidence: 82%

Section: Other/miscellaneousmentioning

confidence: 99%

Section: Other/miscellaneousmentioning

confidence: 99%

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Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

Georgountzos,

Gkalonakis,

Anastasopoulos

et al. 2023

Diagnostics

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“…According to our previous report, all patients underwent standard BHI surgery with general anesthesia ( 27 ). Briefly, a single burr hole was drilled, and irrigation of the hematoma with normal saline was subsequently performed.…”

Section: Methodsmentioning

confidence: 99%

Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma

et al. 2022

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ObjectiveAlthough liver diseases have already been identified as a risk factor for increased recurrence and mortality in patients with chronic subdural hematoma (CSDH), the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between the LF scores and CSDH recurrence.MethodsWe retrospectively analyzed consecutive patients with CSDH who underwent burr-hole irrigation in the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. The clinical data were collected, and the LF scores were calculated including aspartate aminotransferase–platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between the LF scores and CSDH recurrence, and Cox regression model and Fine–Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. The C-statistic, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI) evaluated the additive value of the LF scores to predict the recurrence of CSDH.ResultsA total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas the standard hepatic assays were mostly normal. The patients were assigned to groups of high and low LF scores based on the validated cut-offs; compared with the subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, the LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4, and Forns score were 4.32 (1.37–13.60), 2.56 (1.20–5.43), and 2.02 (1.07–3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the C-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50 and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results.ConclusionsThe data from this study first indicated that the high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.

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“…In recent decades, numerous predictors for recurrence have been suggested, including epidemiological characteristics, radiological findings, clinical symptoms, and even laboratory values: Examples of such prognostic factors are higher age, male sex, hypertension, anticoagulants, hyperdense hematoma components or midline shift on preoperative imaging, and also elevated blood urea nitrogen or low levels of high-density lipoprotein. However, the results between various studies have remained conflicting and partly contradictory [13,26,31,33,34,44,46]. Especially the effects of antithrombotics Alexander Younsi and Lennart Riemann contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

et al. 2021

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In an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

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Elevated blood urea nitrogen is associated with recurrence of post-operative chronic subdural hematoma

Cited by 7 publications

References 27 publications

Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma

Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

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