Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies

Alfotih, Gobran Taha Ahmed; Li, FangCheng; Xu, Xinke; Zhang, ShangYi

doi:10.1016/j.pjnns.2014.08.002

Cited by 15 publications

(8 citation statements)

References 32 publications

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“…Preoperative aneurysm rebleeding has traditionally been a significant reason contributing to morbidity and mortality after aSAH. Previously identified risk factors for preoperative rebleeding have included sex, systolic blood pressure > 160 mm Hg, high Fisher grade, aneurysm characteristics (location, size, and numbers), hyperglycemia, neurological severity ( 5 – 9 , 11 – 13 , 25 – 29 ). Rebleeding following aSAH is a complex and multifactorial event.…”

Section: Discussionmentioning

confidence: 99%

“…The major early complication is aneurysmal rebleeding with an incidence of 4-13.6% during the first 24 h (3,4). Early rebleeding is associated with poor-neurosurgical outcomes and mortality rates as high as 50-80% (3,5). Some studies identified risk factors for preoperative rebleeding have included sex, advanced age, systolic blood pressure >160 mmHg, aneurysm size larger than 10 mm, neurological severity (high Fisher grade and high Hunt-Hess grade), and biomarkers (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…Early rebleeding is associated with poor-neurosurgical outcomes and mortality rates as high as 50-80% (3,5). Some studies identified risk factors for preoperative rebleeding have included sex, advanced age, systolic blood pressure >160 mmHg, aneurysm size larger than 10 mm, neurological severity (high Fisher grade and high Hunt-Hess grade), and biomarkers (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Although the mechanism of rebleeding is poorly understood and controversial, studies have pointed the inflammatory response after aSAH may be related to rebleeding (15,16).…”

Section: Introductionmentioning

confidence: 99%

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Elevated Glucose-Potassium Ratio Predicts Preoperative Rebleeding in Patients With Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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Introduction: Recent reports revealed that higher serum glucose-potassium ratio (GPR) levels at admission were significantly associated with poor outcomes at 3 months following aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to investigate the association between GPR and the risk of rebleeding following aSAH.Methods: This single-center retrospective study of patients with aSAH was conducted in our hospital between January 2008 and December 2020. Patients meeting the inclusion criteria were divided into the rebleed group and the non-rebleed group. Univariate and multivariate analyses were implemented to assess the association between risk factors of rebleeding and outcomes.Results: A total of 1,367 patients experiencing aSAH, 744 patients who met the entry criteria in the study [mean age (54.89 ± 11.30) years; 60.50% female patients], of whom 45 (6.05%) developed rebleeding. The patients in the rebleed group had significantly higher GPR levels than those of patients without rebleeding [2.13 (1.56–3.20) vs. 1.49 (1.23–1.87); p < 0.001]. Multivariable analysis revealed that higher mFisher grade and GPR were associated with rebleeding [mFisher grade, odds ratios (OR) 0.361, 95% CI 0.166–0.783, p = 0.01; GPR, OR 0.254, 95% CI 0.13–0.495, p < 0.001]. The receiver operating characteristics (ROCs) analysis described that the suitable cut-off value for GPR as a predictor for rebleeding in patients with aSAH was determined as 2.09 (the area under the curve [AUC] was 0.729, 95% CI 0.696–0.761, p < 0.0001; the sensitivity was 53.33%, and the specificity was 83.98%). Pearson correlation analysis showed a significant positive correlation between GPR and mFisher grade, between GPR and Hunt–Hess grade (mFisher grade r = 0.4271, OR 0.1824, 95% CI 0.3665–0.4842, p < 0.001; Hunt–Hess grade r = 0.4248, OR 0.1836, 95% CI 0.3697–0.4854, p < 0.001). The patients in the poor outcome had significantly higher GPR levels than those of patients in the good outcome [1.87 (1.53–2.42) vs. 1.45 (1.20–1.80); p < 0.001]. Multivariable analysis demonstrated that GPR was an independent predictor for poor prognosis. The AUC of GPR was 0.709 (95% CI 0.675–0.741; p < 0.0001) (sensitivity = 77.70%; specificity = 55.54%) for poor prognosis.Conclusion: Higher preoperative serum GPR level was associated with Hunt–Hess grade, mFisher grade, rebleeding, and unfunctional outcome, and that they predicted preoperative rebleeding and the 90-days outcome of non-diabetic patients with aSAH, who had potentially relevant clinical implications in patients with aSAH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Elevated Glucose-Potassium Ratio Predicts Preoperative Rebleeding in Patients With Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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“…IL-6, as a kind of glycoprotein, can participate in the collective inflammatory response and anti-infective defense mechanisms ( 13 , 14 ). At present, it is recognized that IL-6 is a kind of multi-functional glycoprotein cell inflammatory factor involved in various inflammatory reactions of central nervous system, which can cause immune response to the brain tissue damage and inflammation ( 15 ). CRP can be synthesized after IL-6 induction, thus activating the body's complement system and improving the immunity ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of changes in IL-6, CRP and S100 in serum and NO in cerebrospinal fluid in subarachnoid hemorrhage and prognosis

Zhang

Sun

et al. 2018

Exp Ther Med

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Clinical significance of changes in interleukin-6 (IL-6), C-reactive protein (CRP) and S100 in serum and NO was investigated in cerebrospinal fluid (CSF) in subarachnoid hemorrhage (SAH) and its prognosis. A total of 43 SAH patients and 23 healthy subjects were selected and divided into cerebral vasospasm (CVS) group and non-CVS group, and favorable prognosis group and unfavorable prognosis group according to Hunt-Hess grade. The levels of IL-6, CRP, S100 and NO in CSF were detected, respectively, followed by statistical analysis of correlation. The higher the Hunt grade was, the higher the factor expression was; the expression levels of IL-6, CRP, S100 and NO in CSF were gradually increased in CVS group and unfavorable prognosis group, and the differences were significant compared with those in the control group. There was a positive correlation between the expression levels of each of the two factors among IL-6, CRP, S100 and NO in CSF, and the differences were statistically significant (P<0.05). The expression levels of IL-6, CRP, S100 and NO in CSF in SAH patients are significantly increased, showing positive correlations and participating in the occurrence and development of SAH, which provide new directions for the early clinical diagnosis of SAH.

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“…DA has a worse clinical outcome, with higher risk of rupture with than SA [5][6][7]. A diameter greater than 10 mm is an independent risk factor for re-bleeding of an aneurysm [8]. The preferred treatment options of DA are vessel occlusion, surgical trapping, or flow diverter [9], whereas clipping or stenting is more frequently used for SA.…”

Section: Introductionmentioning

confidence: 99%

Differentiation of Cerebral Dissecting Aneurysm from Hemorrhagic Saccular Aneurysm by Machine-Learning Based on Vessel Wall MRI: A Multicenter Study

Cao

Zeng

Wang

et al. 2022

JCM

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The differential diagnosis of a cerebral dissecting aneurysm (DA) and a hemorrhagic saccular aneurysm (SA) often depends on the intraoperative findings; thus, improved non-invasive imaging diagnosis before surgery is essential to distinguish between these two aneurysms, in order to provide the correct formulation of surgical procedure. We aimed to build a radiomic model based on high-resolution vessel wall magnetic resonance imaging (VW-MRI) and a machine-learning algorithm. In total, 851 radiomic features from 146 cases were analyzed retrospectively, and the ElasticNet algorithm was used to establish the radiomic model in a training set of 77 cases. A clinico-radiological model using clinical features and MRI features was also built. Then an integrated model was built by combining the radiomic model and clinico-radiological model. The area under the ROC curve (AUC) was used to quantify the performance of models. The models were evaluated using leave-one-out cross-validation in a training set, and further validated in an external test set of 69 cases. The diagnostic performance of experienced radiologists was also assessed for comparison. Eight features were used to establish the radiomic model, and the radiomic model performs better (AUC = 0.831) than the clinico-radiological model (AUC = 0.717), integrated model (AUC = 0.813), and even experienced radiologists (AUC = 0.801). Therefore, a radiomic model based on VW-MRI can reliably be used to distinguish DA and hemorrhagic SA, and, thus, be widely applied in clinical practice.

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Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies

Cited by 15 publications

References 32 publications

Elevated Glucose-Potassium Ratio Predicts Preoperative Rebleeding in Patients With Aneurysmal Subarachnoid Hemorrhage

Elevated Glucose-Potassium Ratio Predicts Preoperative Rebleeding in Patients With Aneurysmal Subarachnoid Hemorrhage

Clinical significance of changes in IL-6, CRP and S100 in serum and NO in cerebrospinal fluid in subarachnoid hemorrhage and prognosis

Differentiation of Cerebral Dissecting Aneurysm from Hemorrhagic Saccular Aneurysm by Machine-Learning Based on Vessel Wall MRI: A Multicenter Study

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