Trends in Hospitalization and Mortality Rates Associated with Subarachnoid Hemorrhage and Unruptured Cerebral Aneurysms in Brazil.

BACKGROUND: Epidemiology of spontaneous subarachnoid hemorrhage (SAH) and unruptured intracranial aneurysm (UIA) is valuable for determining neurosurgical and general health care effectiveness. There is an information gap regarding these conditions in middle- and low-income countries. Therefore, we aimed to investigate hospitalization and mortality rates for SAH and UIA in Brazil from 2011 to 2019. METHODS: This observational, population-based study used hospital admission and mortality data and included all SAH- and UIA-related public hospitalizations and deaths occurring from 2011 to 2019. Data were obtained from the Ministry of Health National Hospitalisation and Mortality Information Systems. Population data were obtained from the Brazilian Institute of Geography and Statistics. Simple linear regression models with normal responses were adjusted to explain the temporal evolution of variables. Joinpoint regression models were adjusted to detect moments of significant change in variable behavior. Graduated choropleth maps were generated using georeferencing and geospatial analyses. RESULTS: Annual SAH hospitalization and mortality coefficients were 4.81/100,000 and 2.49/100,000 persons, respectively. UIA hospitalization and mortality coefficients were 1.21/100,000 and 0.24/100,000 persons, respectively. In addition to regional differences, we found a stable SAH hospitalization trend and an increasing mortality rate of 0.062 cases/100,000 inhabitants annually. The UIA hospitalization rate increased by 0.074 cases/100,000 inhabitants annually, and mortality decreased by 0.07 deaths/100,000 inhabitants annually. CONCLUSIONS: In Brazil, the SAH hospitalization trend is stable, although there is a worrisome increasing SAH-related mortality trend. A better scenario was observed for UIA, with an increase in hospitalizations and decrease in mortality.

Prevalence and risk factors of unruptured intracranial aneurysms in ischemic stroke patients - A global meta-analysis.

Background: Unruptured intracranial aneurysms (UIAs) have an estimated global prevalence of 2.8% in the adult population; however, UIA was identified among more than 10% of ischemic stroke patients. Many epidemiological studies and reviews have pointed to the presence of UIA among patients with ischemic stroke; yet, the extent of this association is not fully known. We performed a systematic review and meta-analysis to determine the prevalence of UIA in patients admitted to hospitals with ischemic stroke and transient ischemic attack (TIA) at both global and continental levels and evaluate factors associated with UIA in this population. Methods: We identified, in five databases, all studies describing UIA in ischemic stroke and TIA patients between January 1, 2000, and December 20, 2021. Included studies were of observational and experimental design. Results: Our search yielded 3581 articles of which 23 were included, with a total of 25,420 patients. The pooled prevalence of UIA was 5% (95% confidence interval [CI] = 4-6%) with stratified results showing 6% (95% CI = 4-9%), 6% (95% CI = 5-7%), and 4% (95% CI = 2-5%) in North America, Asia, and Europe, respectively. Significant risk factors were large vessel occlusion (odds ratios [OR] = 1.22, 95% CI = 1.01-1.47) and hypertension (OR = 1.45, 95% CI = 1.24-1.69), while protective factors were male sex (OR = 0.60, 95% CI = 0.53-0.68) and diabetes (OR = 0.82, 95% CI = 0.72-0.95). Conclusion: The prevalence of UIA is notably higher in ischemic stroke patients than the general population. Physicians should be aware of common risk factors in stroke and aneurysm formation for appropriate prevention.

Influence of Serum Ferritin and B12 Levels in the Functional Outcomes of Patients with Ruptured and Unruptured Intracranial Aneurysms / Influência dos níveis séricos de ferritina e B12 nos desfechos funcionais de pacientes com aneurismas intracranianos rotos e não rotos

Introduction Pathological processes in the arterial wall that result in vessel dilation are the cause of intracranial aneurysms (IAs), and the risk factors for their formation and progression are not well established. Ferritin is associated with inflammation and angiogenesis; it has protective antioxidative activity, and controls cell differentiation. Vitamin B12 is related to neurological and hematological disorders; it can be used as differential diagnosis tool, and acts in the control of homocysteinemia, a predictor of worse prognosis. The present article aims to assess the correlation between serum ferritin and B12 levels and the patient's functional outcome. Materials and Methods In the present cohort study, we assessed the serum levels of ferritin and B12, as well as the scores on the modified Rankin and Glasgow Outcome Scales at 6 months, of 2 groups, one with 19 and the other with 49 individuals, out of 401 patients treated for IA at Universidade de São Paulo from 2018 to 2019. We performed a statistical analysis, using logistic regression, to determine the aforementioned correlation. Results In the univariable analysis, the serum levels of ferritin showed no significant impact on the functional outcome (odds ratio [OR]: 0.96 for every 100 pg/mL increase; 95% confidence interval [95%CI]: 0.761­1.210; p » 0.732); neither did the serum levels of B12 (OR: 0.998 for every 100 pg/mL increase; 95%CI: 0.826­1.206; p » 0.987). Moreover, no significant impact on the functional outcome was observed in the multivariable analysis regarding the serum levels of B12, age, hypertension, and aneurysm rupture (OR: 1.086 for every 100 pg/mL increase; 95%CI: 0.847­1.392; p » 0.513). Conclusion We were not able to confirm a statistical correlation regarding the serum levels of ferritin and B12, and functional outcome of IA patients. These variables might be linked to other determinants of the pathophysiology of IAs, like inflammation and homocysteinemia.

Introdução Processos patológicos na parede arterial, que resultam em dilatação dos vasos, são a causa dos aneurismas intracranianos (AIs), e os fatores de risco para a sua formação e evolução não estão bem estabelecidos. A ferritina está associada a inflamação e angiogênese, tem atividade antioxidante, e controla diferenciação celular. A vitamina B12 está relacionada a distúrbios neurológicos e hematológicos, é utilizada como ferramenta de diagnóstico, e atua no controle da homocisteinemia. Este artigo visa avaliar a correlação entre os níveis séricos de ferritina e B12 e o desfecho funcional do paciente. Materiais e Métodos Neste estudo de coorte, analisamos os níveis séricos de ferritina e B12, assim como as pontuações nas escalas de desfechos de Rankin modificada e Glasgow aos 6 meses de 2 grupos, um com 19 e o outro com 49 indivíduos, dos 401 pacientes com AI tratados na Universidade de São Paulo de 2018 a 2019. Para determinar a já mencionada correlação, realizamos análise estatística usando regressão logística. Resultados Na análise univariada, a ferritina sérica não resultou em impacto significativo sobre o desfecho funcional (razão de possibilidades [RP]: 0,96 para cada aumento de 100 pg/mL; intervalo de confiança de 95% [IC95%]: 0,761­1,210; p » 0,732), nem a B12 sérica (RP: 0,998 para cada aumento de 100 pg/mL; IC95%: 0,826­1,206; p » 0,987). Tampouco observou-se impacto significativo sobre o desfecho na análise multivariada usando B12 sérica, idade, hipertensão e ruptura de aneurisma (RP: 1,086 para cada aumento de 100 pg/mL; IC95%: 0,847­1,392; p » 0,513). Conclusão Não foi confirmada a correlação estatística entre os níveis séricos de ferritina e de B12 e o desfecho funcional de pacientes com AI. Essas variáveis podem estar ligadas a outros determinantes da fisiopatologia do AI, como inflamação e homocisteinemia.