Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 784
Filtrar
1.
Am J Med Sci ; 361(2): 261-268, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33526214

RESUMO

BACKGROUND: The most vexing problem in hyponatremic conditions is to differentiate the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral/renal salt wasting (C-RSW). Both have identical clinical parameters but diametrically opposite therapeutic goals of water- restricting water-logged patients with SIADH or administering salt and water to dehydrated patients with C-RSW. While C-RSW is considered a rare condition, the report of a high prevalence of C-RSW in the general hospital wards creates an urgency to differentiate one syndrome from the other on first encounter. We decided to identify the natriuretic factor (NF) we previously demonstrated in plasma of neurosurgical and Alzheimer diseases (AD) who had findings consistent with C-RSW. METHODS: We performed the same rat renal clearance studies to determine natriuretic activity (NA) in serum from a patient with a subarachnoid hemorrhage (SAH) and another with AD and demonstrated NA in their sera. The sera were subjected to proteomic and SWATH (Sequential Windowed Acquisition of All) analyses which identified increased levels of haptoglobin related protein (Hpr) without signal peptide (Hpr-WSP). RESULTS: Recombinant Hpr with His tag at the N terminus had no NA. Hpr-WSP had a robust NA in a dose-dependent manner when injected into rats. Serum after recovery from C-RSW in the SAH patient had no NA. CONCLUSIONS: Hpr-WSP may be the NF in C-RSW which should be developed as a biomarker to differentiate C-RSW from SIADH on first encounter, introduces a new syndrome of C-RSW in AD and can serve as a proximal diuretic to treat congestive heart failure.


Assuntos
Doença de Alzheimer/sangue , Antígenos de Neoplasias/sangue , Natriuréticos/sangue , Hemorragia Subaracnóidea/sangue , Desequilíbrio Hidroeletrolítico/sangue , Idoso , Animais , Biomarcadores/sangue , Encéfalo/metabolismo , Feminino , Haptoglobinas , Humanos , Rim/metabolismo , Masculino , Ratos , Síndrome
2.
J Stroke Cerebrovasc Dis ; 29(11): 105208, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066948

RESUMO

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is both a hypercoagulable and inflammation state in which many biomarkers have been studied. Activated platelets have been identified to be of clinical importance in thrombosis and neuroinflammation after aSAH. The aim of this study was to investigate the relationship between mean platelet volume (MPV) to platelet count (PC) ratio, a surrogate parameter for activated platelets, and the functional outcome in aSAH patients. METHODS: A retrospective analysis was performed of patients with aSAH admitted to the stroke center of our institution between November 2018 and November 2019. The mean MPV/PC ratio during the first three days after aSAH onset was calculated. Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 3 months. Receive operating characteristic (ROC) curve analysis was performed to determine the optimal value of MPV/PC ratio for the prediction of poor outcome in patients with aSAH. RESULTS: A total of 100 patients were included, 13 (13.0%) died and 35 (35.0%) had a poor outcome. Mean MPV/PC ratio (P < 0.001) when measured over the study period, was significantly higher among patients with poor outcome. In multivariable analysis, increased mean MPV/PC ratio was associated with poor functional outcome at 3 months (odds ratio (OR) = 1.94; 95% confidence interval (CI): 1.19-3.17; P = 0.008). The optimal cutoff of MPV/PC ratio for predicting poor outcome at 3 months was 6.77 (sensitivity 74.3%, specificity 61.5%). CONCLUSION: An increased MPV/PC ratio is associated with poor functional outcome in aSAH patients. MPV/PC ratio may be a useful predictor of outcome after aSAH.


Assuntos
Plaquetas , Volume Plaquetário Médio , Ativação Plaquetária , Contagem de Plaquetas , Hemorragia Subaracnóidea/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
3.
J Clin Neurosci ; 78: 108-113, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600972

RESUMO

Subarachnoid hemorrhage (SAH) can trigger immune activation sufficient to induce systematic inflammatory response syndrome (SIRS). Serum inflammatory biomarkers and SIRS can predict a poor outcome. The relationship between surgical stress and inflammatory response is well known but described in few reports in the neurosurgical population. We aimed to ascertain whether postoperative SIRS and initial serum biomarkers were associated with outcomes and evaluate whether the postoperative SIRS score differed between those with clipping and coil embolization. We evaluated 87 patients hospitalized within 24 h from onset of nontraumatic SAH. Serum biomarkers, such as levels of C-reactive protein (CRP), white blood cells (WBC), and D-dimer, as well as stress index (SI: blood sugar/K ratio) were obtained at admission. SIRS scores 3 days after admission were derived by adding the number of variables meeting the standard criteria (heart rate [HR] >90, respiratory rate [RR] >20, temperature >38 °C or <36 °C, and WBC count <4000 or >12,000). Clinical variables were compared according to whether they were associated with poor outcomes. Coil embolization was performed in 30 patients and clipping in 57. WBC, SI, D-dimer levels, and SIRS scores were significantly higher in patients with poor-grade SAH and were associated with poor outcomes. SIRS scores were significantly higher with clipping than with coil embolization among patients with good-grade SAH without intracerebral hemorrhage. Acute SIRS and serum biomarkers predict outcomes after SAH. Moreover, our study suggests the influence of surgical invasion via clipping on SIRS after SAH.


Assuntos
Proteína C-Reativa/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/cirurgia , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Leucócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Hemorragia Subaracnóidea/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Resultado do Tratamento
4.
BMC Neurol ; 20(1): 112, 2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32220241

RESUMO

BACKGROUND: The purpose of this study was to evaluate the role of C-reactive protein (CRP) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH). METHODS: In this retrospective, observational study of adult patients with SAH treated between January 2012 and June 2017. Initial CRP levels collected within 24 h from the onset of SAH, the follow-up CRP levels were measured. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). RESULTS: Among 156 patients with SAH, 145 (92.9%) survived until discharge. Of these survivors, 109 (69.9%) manifested favorable neurological outcomes (GOS of 4 or 5). Initial CRP levels on admission and maximal CRP levels within four days were significantly higher in the group with poor neurological outcome compared with those manifesting favorable neurological outcomes (P = 0.022, P < 0.001, respectively). However, the clearance of CRPs did not differ significantly between the two groups (P = 0.785). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that the performance of the maximal CRP was significantly better compared with the initial CRP or the clearance of CRP (P = 0.007, P < 0.001, respectively). In this study, the effect of CRP on neurological outcomes differed according to surgical clipping. The maximal CRP levels within four days facilitate the prediction of neurological outcomes of SAH patients without surgical clipping (C-statistic: 0.856, 95% confidence interval [CI]: 0.767-0.921). However, they were poorly associated with neurological prognoses in SAH patients who underwent surgical clipping (C-statistic: 0.562, 95% CI: 0.399-0.716). Multivariable logistic regression analysis revealed that age (adjusted odds ratio [OR]: 1.10, 95% CI: 1.052-1.158), initial Glasgow Coma Scale (adjusted OR: 0.74, 95% CI: 0.647-0.837), and maximal CRP without surgical clipping (adjusted OR: 1.27, 95% CI: 1.066-1.516) were significantly associated with poor neurological outcomes in SAH patients. CONCLUSIONS: Early serial measurements of CRP may be used to predict neurological outcomes of SAH patients. Furthermore, maximal CRP levels within four days post-SAH are significantly correlated with poor neurological outcomes.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Hemorragia Subaracnóidea/sangue , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos
5.
World Neurosurg ; 138: e317-e322, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112936

RESUMO

OBJECTIVE: The relationship between neutrophil-lymphocyte ratio (NLR) and the occurrence of rebleeding in aneurysmal subarachnoid hemorrhage (aSAH) is poorly understood. Our study aimed to investigate the association between NLR on admission and rebleeding following aSAH. METHODS: Clinical and laboratorial data from patients with aSAH were retrospectively collected, including leukocyte, neutrophil, lymphocyte, and NLR. Univariate and multivariate analyses were performed to assess for the association of NLR with rebleeding. We performed propensity-score matching analyses to correct imbalances in patient characteristics between the rebleeding group and nonrebleeding group. RESULTS: Rebleeding occurred in 30 of 716 (4.19%) patients with aSAH in this cohort. Patients with rebleeding had significantly higher NLR comparing with patients without rebleeding (11.27 vs. 5.5; P < 0.05) in the univariate analysis. In the multivariate analysis, NLR was considered as a risk factor of rebleeding (odds ratio, 0.283; 95% confidence interval, 0.130-0.620; P = 0.002), as well as Fisher grade (odds ratio, 0.353, 95% confidence interval, 0.151-0.824; P = 0.016). The area under the curve of the NLR and combined NLR-Fisher grade model was 0.702 and 0.744 (sensitivity was 39.94%, and specificity was 100%) for predicting rebleeding, respectively. After propensity-score matching, the optimal cutoff value for NLR as a predictor for rebleeding following aSAH was determined as 5.4 (sensitivity was 83.33%, and the specificity was 63.33%). CONCLUSIONS: Higher NLR predicts the occurrence of rebleeding and poor outcome, and NLR combined with Fisher grade significantly improves the prediction of rebleeding following aSAH.


Assuntos
Biomarcadores/sangue , Linfócitos , Neutrófilos , Hemorragia Subaracnóidea/sangue , Idoso , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/cirurgia , Instrumentos Cirúrgicos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
6.
Stroke ; 51(4): 1128-1134, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32156203

RESUMO

Background and Purpose- We evaluated the association between 2 types of predictors of delayed cerebral ischemia after nontraumatic subarachnoid hemorrhage, including biomarkers of the innate immune response and neurophysiologic changes on continuous electroencephalography. Methods- We studied subarachnoid hemorrhage patients that had at least 72 hours of continuous electroencephalography and blood samples collected within the first 5 days of symptom onset. We measured inflammatory biomarkers previously associated with delayed cerebral ischemia and functional outcome, including soluble ST2 (sST2), IL-6 (interleukin-6), and CRP (C-reactive protein). Serial plasma samples and cerebrospinal fluid sST2 levels were available in a subgroup of patients. Neurophysiologic changes were categorized into new or worsening epileptiform abnormalities (EAs) or new background deterioration. The association of biomarkers with neurophysiologic changes were evaluated using the Wilcoxon rank-sum test. Plasma and cerebrospinal fluid sST2 were further examined longitudinally using repeated measures mixed-effects models. Results- Forty-six patients met inclusion criteria. Seventeen (37%) patients developed new or worsening EAs, 21 (46%) developed new background deterioration, and 8 (17%) developed neither. Early (day, 0-5) plasma sST2 levels were higher among patients with new or worsening EAs (median 115 ng/mL [interquartile range, 73.8-197]) versus those without (74.7 ng/mL [interquartile range, 44.8-102]; P=0.024). Plasma sST2 levels were similar between patients with or without new background deterioration. Repeated measures mixed-effects modeling that adjusted for admission risk factors showed that the association with new or worsening EAs remained independent for both plasma sST2 (ß=0.41 [95% CI, 0.09-0.73]; P=0.01) and cerebrospinal fluid sST2 (ß=0.97 [95% CI, 0.14-1.8]; P=0.021). IL-6 and CRP were not associated with new background deterioration or with new or worsening EAs. Conclusions- In patients admitted with subarachnoid hemorrhage, sST2 level was associated with new or worsening EAs but not new background deterioration. This association may identify a link between a specific innate immune response pathway and continuous electroencephalography abnormalities in the pathogenesis of secondary brain injury after subarachnoid hemorrhage.


Assuntos
Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/diagnóstico , Idoso , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Isquemia Encefálica/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Solubilidade , Hemorragia Subaracnóidea/fisiopatologia
7.
World Neurosurg ; 138: e523-e529, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32151773

RESUMO

OBJECTIVE: Increasing evidence points monocytes' role to be larger than thought in developing cerebral infarction (CI) after subarachnoid hemorrhage (SAH). However, there is no clinical evidence of the relationship between peripheral monocytes and CI and clinical outcomes. Therefore we determine whether an increase in monocytes in the acute phase is useful to predict CI and functional outcomes in SAH patients. METHODS: We included 204 patients with an SAH diagnosis. We collected patient-related factors, comorbidities, Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia, CI, aneurysm characteristics, and peripheral monocytes from vein blood at admission. Poor outcomes were defined as modified Rankin Scale score ≥3. RESULTS: Fifty (24.5%) patients had CI before discharge. In a multivariate model, increased monocytes at admission were significantly associated with CI after adjusting for IV-V Hunt-Hess grade and delayed cerebral ischemia (odds ratio: 3.193, 95% confidence interval: 1.069-9.532, P = 0.037). In receiver operating characteristic curve analysis, a monocyte count of 0.60 was identified as the best cutoff value to discriminate the development of CI (area under the curve = 0.622, P = 0.010; CI for monocytes <0.60 17.4% vs. CI for monocytes ≥0.60 29.1% P = 0.046). Admission monocytes ≥0.60 predicted poor functional outcomes at discharge (monocytes <0.60 52% vs. monocytes ≥0.60 64.7%) and at 12 months (monocytes <0.60 29.4% vs. monocytes ≥0.60 70.6%). CONCLUSIONS: Increased peripheral monocytes at admission is a risk factor for developing CI after SAH. Moreover, short- and long-term poor clinical outcomes were associated with higher monocyte count. Therefore monocytes could be a convenient biomarker for prognosis unfavorable outcomes and a possible target for new therapeutic strategies.


Assuntos
Infarto Cerebral/diagnóstico , Monócitos , Hemorragia Subaracnóidea/diagnóstico , Adulto , Idoso , Infarto Cerebral/sangue , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/sangue , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 29(5): 104770, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173226

RESUMO

OBJECTIVE: To investigate the association of early serum calprotectin (S100A8/A9) level with disease severity and prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). PATIENTS AND METHODS: Serum samples were collected from 54 patients with aSAH (within 48 hours of onset) and 54 health controls. Levels of serum calprotectin were determined by enzyme linked immunosorbent assay. The clinical data of aSAH patients were collected. The prognosis was evaluated by modified Rankin scale at 3 months. Univariate and multivariable logistic regression analysis, bivariate correlation analysis and receiver operating characteristic (ROC) curve analysis were used respectively. RESULTS: Serum calprotectin levels were significantly higher in aSAH patients than that in healthy controls (P < .001). The clinical severity was also significantly correlated with the level of serum calprotectin. Patients with poor prognosis at 3 months showed higher serum calprotectin levels within 48 hours of onset than that in patients with good prognosis (P = .002). The level of serum calprotectin within 48 hours was related to the complications of secondary pneumonia. Serum calprotectin can be used as an independent predictor for delayed cerebral ischemia (DCI) after aSAH and poor prognosis in patients with aSAH at 3 months. The ROC curve showed the cutoff value of calprotectin for predicting poor prognosis at 3 months was 6020 pg/ml (sensitivity: 53.57%, specificity: 96.15%), and the cutoff value for predicting DCI was 5275 pg/ml (sensitivity: 68.42%, specificity: 82.86%). CONCLUSION: Serum calprotectin concentrations within 48 hours after onset was significantly correlated with the clinical severity and the poor prognosis at 3 months in aSAH patients, suggesting that serum calprotectin may be a biomarker for early prediction of prognosis and complications in patients with aSAH and calprotectin may be a target for the treatment of aSAH.


Assuntos
Isquemia Encefálica/etiologia , Calgranulina A/sangue , Calgranulina B/sangue , Hemorragia Subaracnóidea/sangue , Idoso , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Bases de Dados Factuais , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Fatores de Tempo , Regulação para Cima
9.
PLoS One ; 15(2): e0227349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097426

RESUMO

OBJECTIVE: The amount of extravasated blood is an established surrogate marker for subarachnoid hemorrhage (SAH) severity, which varies in different experimental SAH (eSAH) models. A comprehensive eSAH grading system would allow a more reliable correlation of outcome parameters with SAH severity. The aim of this study was to define a severity score for eSAH related to the Fisher-Score in humans. MATERIAL AND METHODS: SAH was induced in 135 male rats using the modified double hemorrhage model. A sham group included 8 rats, in which saline solution instead of blood was injected. Histological analysis with HE(hematoxylin-eosin)-staining for the visualization of blood was performed in all rats on day 5. The amount and distribution of blood within the subarachnoid space and ventricles (IVH) was analyzed. RESULTS: The mortality rate was 49.6% (71/143). In all except five SAH rats, blood was visible within the subarachnoid space. As expected, no blood was detected in the sham group. The following eSAH severity score was established (ESAS-score): grade I: no SAH visible; grade II: local or diffuse thin SAH, no IVH; grade III: diffuse / thick layers of blood, no IVH; grade IV: additional IVH. Grade I was seen in five rats (7.9%), grade II in 28.6% (18/63), grade III in 41.3% (26/63) and grade IV in 22.2% (14/63) of the rats with eSAH. CONCLUSION: The double hemorrhage model allows the induction of a high grade SAH in more than 60% of the rats, making it suitable for the evaluation of outcome parameters in severe SAH.


Assuntos
Ventrículos Cerebrais/patologia , Hemorragia Subaracnóidea/patologia , Espaço Subaracnóideo/patologia , Animais , Modelos Animais de Doenças , Masculino , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/sangue
10.
Int J Mol Sci ; 21(5)2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32106601

RESUMO

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is a highly complex disease with very high mortality and morbidity. About one-third of SAH patients suffer from systemic infections, predominantly pneumonia, that can contribute to excess mortality after SAH. Immunodepression is probably the most important mechanism leading to infections. Interleukin-10 (IL-10) is a master regulator of immunodepression, but it is still not clear if systemic IL-10 levels contribute to immunodepression, occurrence of infections and clinical outcome after SAH. METHODS: This explorative study included 76 patients with SAH admitted to our neurointensive care unit within 24 h after ictus. A group of 24 patients without any known intracranial pathology were included as controls. Peripheral venous blood was withdrawn on day 1 and day 7 after SAH. Serum was isolated by centrifugation and stored at -80 °C until analysis. Serum IL-10 levels were determined by enzyme-linked immunoassay (ELISA). Patient characteristics, post-SAH complications and clinical outcome at discharge were retrieved from patients' record files. RESULTS: Serum IL-10 levels were significantly higher on day 1 and day 7 in SAH patients compared to controls. Serum IL-10 levels were significantly higher on day 7 in patients who developed any kind of infection, cerebral vasospasm (CVS) or chronic hydrocephalus. Serum IL-10 levels were significantly higher in SAH patients discharged with poor clinical outcome (modified Rankin Scale (mRS) 3-6 or Glasgow Outcome Scale (GOS) 1-3). CONCLUSION: Serum IL-10 might be an additional useful parameter along with other biomarkers to predict post-SAH infections.


Assuntos
Pneumonia Associada a Assistência à Saúde/sangue , Interleucina-10/sangue , Meningite/sangue , Hemorragia Subaracnóidea/sangue , Idoso , Biomarcadores/sangue , Feminino , Pneumonia Associada a Assistência à Saúde/epidemiologia , Pneumonia Associada a Assistência à Saúde/etiologia , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/complicações , Masculino , Meningite/epidemiologia , Meningite/etiologia , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/etiologia
11.
Acta Neurochir (Wien) ; 162(3): 545-552, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31915942

RESUMO

BACKGROUND: Myelin basic protein (MBP) is the second most abundant protein in central nervous system myelin. Since the 1980s, it has been regarded as a marker of brain tissue injury in both trauma and disease. There have been no recent reports regarding MBP in aneurysmal subarachnoid haemorrhage (SAH). METHODS: One hundred four SAH patients with ruptured aneurysms underwent endovascular treatment within 24 h of rupture, and 156 blood samples were collected: 104 on days 0-3, 32 on days 4-6 and 20 on days 9-12 post-SAH. MBP levels were assayed using ELISA and compared with the clinical status on admission, laboratory results, imaging findings and treatment outcome at 3 months. RESULTS: MBP levels on days 0-3 post-SAH were significantly higher among poor outcome patients (p < 0.001), non-survivors (p = 0.005), patients who underwent intracranial intervention (p < 0.001) and patients with intracerebral haemorrhage (ICH; p < 0.001). On days 4-6 post-SAH, significantly higher levels were found following intracranial intervention (p = 0.009) and ICH (p = 0.039). There was clinically relevant correlation between MBP levels on days 0-3 post-SAH and 3-month Glasgow Outcome Scale (cc = - 0.42) and also ICH volume (cc = 0.48). All patients who made a full recovery had MBP levels below detection limit on days 0-3 post-SAH. Following endovascular aneurysm occlusion, there was no increase in MBP in 86 of the 104 patients investigated (83%). CONCLUSIONS: The concentration of MBP in peripheral blood after intracranial aneurysm rupture reflects the severity of the brain tissue injury (due to surgery or ICH) and correlates with the treatment outcome. Endovascular aneurysm occlusion was not followed by a rise in MBP in most cases, suggesting the safety of this technique.


Assuntos
Aneurisma Roto/sangue , Encéfalo/patologia , Proteína Básica da Mielina/sangue , Hemorragia Subaracnóidea/sangue , Adulto , Idoso , Aneurisma Roto/patologia , Aneurisma Roto/cirurgia , Biomarcadores/sangue , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/cirurgia
12.
BMC Neurol ; 20(1): 31, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959120

RESUMO

BACKGROUND: While both hypercapnia and hypocapnia are harmful in patients with subarachnoid hemorrhage (SAH), it is unknown whether high-normal PaCO2 values are better than low-normal values. We hypothesized that high-normal PaCO2 values have more detrimental than beneficial effects on outcome. METHODS: Consecutive patients with aneurysmal subarachnoid hemorrhage (aSAH) requiring mechanical ventilation treated in a tertiary care university hospital were retrospectively analyzed regarding the influence of PaCO2 on favorable outcome, defined as modified Rankin scale score < 3 at discharge. Primary endpoint was the difference in the proportion of PaCO2 values above 40 mmHg in relation to all measured PaCO2 values between patients with favorable and unfavorable outcome. RESULTS: 150 patients were included. Median age was 57 years (p25:50, p75:64), median Hunt-Hess score was 4 (p25:3, p75:5). PaCO2 values were mainly within normal range (median 39.0, p25:37.5, p75:41.4). Patients with favorable outcome had a lower proportion of high-normal PaCO2 values above 40 mmHg compared to patients with unfavorable outcome (0.21 (p25:0.13, p75:0.50) vs. 0.4 (p25:0.29, p75:0.59)) resulting in a lower chance for favorable outcome (OR 0.04, 95% CI 0.00-0.55, p = 0.017). In multivariable analysis adjusted for Hunt-Hess score, pneumonia and length of stay, elevated PaCO2 remained an independent predictor of outcome (OR 0.05, 95% CI 0.00-0.81, p = 0.035). CONCLUSIONS: A higher proportion of PaCO2 values above 40 mmHg was an independent predictor of outcome in patients with aSAH in our study. The results need to be confirmed in a prospective trial.


Assuntos
Dióxido de Carbono/sangue , Respiração Artificial , Hemorragia Subaracnóidea/sangue , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
13.
J Stroke Cerebrovasc Dis ; 29(4): 104631, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31964576

RESUMO

Background Recent studies of patients with intracerebral hemorrhage suggest an association between peripheral blood neutrophil-lymphocyte ratio and neurologic deterioration. We aimed to study the prognostic utility of neutrophil-lymphocyte ratio in predicting inpatient mortality in aneurysmal subarachnoid hemorrhage. Methods We conducted a retrospective electronic medical record review of the clinical, laboratory, and radiographic data of patients with aneurysmal subarachnoid hemorrhage 18 years of age or older presenting to the neuroscience intensive care unit from January 1, 2011, to December 31, 2017. Patients with aneurysmal subarachnoid hemorrhage were divided into 2 groups (group 1, alive at discharge; group 2, deceased prior to discharge), and neutrophil-lymphocyte ratio laboratory mean values were recorded for each patient. Our primary outcome measure was inpatient mortality, and our secondary measure was incidence of pneumonia with hospitalization. Results We identified 403 patients with aneurysmal subarachnoid hemorrhage for the study. After exclusion criteria, 44 eligible patients were divided into the 2 groups (group 1, n = 32; group 2, n = 12). Mean neutrophil-lymphocyte ratio for group 1 was 11.53, and for group 2, 17.85 (P < .01). The mean neutrophil-lymphocyte ratio of those who developed pneumonia compared to those who did not was 15.28 versus 12.81, respectively (P = .39). A Kaplan-Meier plot demonstrated increased mortality among patients with a neutrophil-lymphocyte ratio equal to or greater than 12.5 compared to those with a neutrophil-lymphocyte ratio less than 12.5. Conclusions These preliminary data demonstrate that a neutrophil-lymphocyte ratio equal to or greater than 12.5 at admission predict higher inpatient mortality in patients with aneurysmal subarachnoid hemorrhage.


Assuntos
Linfócitos/imunologia , Neutrófilos/imunologia , Hemorragia Subaracnóidea/imunologia , Adulto , Idoso , Registros Eletrônicos de Saúde , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Readmissão do Paciente , Pneumonia/imunologia , Pneumonia/mortalidade , Pneumonia/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/terapia
14.
J Stroke Cerebrovasc Dis ; 29(3): 104558, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31889655

RESUMO

BACKGROUND: Identifying patients at risk for delayed cerebral ischemia after an aneurysmal subarachnoid hemorrhage remains challenging and both delayed treatment and over-treatment are reasonable concerns. OBJECTIVE: To evaluate the role of the serum markers C-reactive protein, white blood count, and d-dimer as prognostic factors for the occurrence of delayed cerebral ischemia. METHODS: All patients admitted within 24 hours after an aneurysmal subarachnoid hemorrhage were included over a 6-year period. The World Federation of Neurosurgery and Fisher grading scales as well as the extended Glasgow Outcome Scale were documented at discharge and after a 3-to-6-month follow-up period. C-reactive protein, d-dimer, white blood count, and procalcitonin were assessed on admission, day 1, day 4, day 9, day 14, and at discharge. Radiologically confirmed delayed cerebral ischemia before discharge was the primary endpoint. Severe angiographic vasospasm and outcome were used as secondary endpoints. RESULTS: Delayed cerebral ischemia occurred in 19.6% of the 138 patients included. Delayed cerebral ischemia correlated with severe vasospasm and with a worse outcome. Serum C-reactive protein levels were higher in patients with severe vasospasm during the period of vasospasm. D-dimer levels on admission correlated with Fisher grades. Delayed cerebral ischemia occurred more frequently in patients with Fisher grade IV hemorrhage, if d-dimer levels were higher on admission. The cut-off was .445 µg/ml. CONCLUSION: Our observations support a multifactorial genesis for delayed cerebral ischemia, including vasospasm and microthrombotic and inflammatory processes. Serum d-dimer levels greater than .445 µg/ml might be a predictor for the occurrence of delayed cerebral ischemia in patients with a Fisher grade IV aneurysmal subarachnoid hemorrhage.


Assuntos
Isquemia Encefálica/sangue , Proteína C-Reativa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Aneurisma Intracraniano/sangue , Hemorragia Subaracnóidea/sangue , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Diagnóstico Precoce , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Trombose Intracraniana/sangue , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Fatores de Tempo , Vasoespasmo Intracraniano/sangue , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia
15.
World Neurosurg ; 136: e181-e195, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31887461

RESUMO

BACKGROUND: There is limited knowledge of whether hypercoagulability is present after subarachnoid hemorrhage (SAH) or about its timing of onset, duration, and severity. To conduct a pilot new-generation thromboelastography (TEG) technology (TEG6s)-based and conventional coagulation test-supported longitudinal assessment of coagulation in patients with SAH. METHODS: We prospectively enrolled patients with nontraumatic SAH on admission from May 2015 to May 2016. We performed TEG6s measurements and conventional coagulation tests on days 1, 2, 3, 5, 7, 10, and 14 and compared them with TEG6s parameters in healthy volunteers. RESULTS: We studied 14 patients and 72 TEG6s measurements. Of these patients, 10 (71.4%) were admitted to the intensive care unit. Mean age was 57.5 (±14.5) years, Acute Physiology and Chronic Health Evaluation III score 58.2 (±26.6), length of hospital stay was 23 (±11.7) days, and mortality was 14.3%. At baseline, conventional coagulation tests were within normal range. However, TEG6s parameters already showed increased coagulability. Thereafter, alpha angle, reaction time, functional fibrinogen level, and maximum amplitude rapidly and significantly increased (P < 0.01) compared with healthy controls. Ten (71.4%) patients demonstrated a >20% increase in coagulability based on TEG6s parameters from their baseline. Moreover, TEG6s hypercoagulability peaked at day 10 and only showed an initial partial decline towards normal by day 14. Similarly, platelet counts and fibrinogen levels increased over this period (P < 0.01) CONCLUSIONS: Using TEG6s technology, we found significant and progressive hypercoagulability in 70% of patients, with an early dominant contribution from hyperfibrinogenemia and increased fibrin formation and partial contribution from thrombocytosis, beginning on the first day, increasing to peak values by day 10, and then partly declining toward normal by day 14.


Assuntos
Coagulação Sanguínea/fisiologia , Hemorragia Subaracnóidea/sangue , Trombofilia/sangue , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Hemorragia Subaracnóidea/complicações , Tromboelastografia , Trombofilia/etiologia
16.
J Stroke Cerebrovasc Dis ; 29(3): 104536, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883781

RESUMO

BACKGROUND: Microthrombosis after subarachnoid hemorrhage has an adverse effect on prognosis. Milk fat globule-epidermal growth factor 8 promotes phagocytosis of phagocytic cells and may reduce microthrombosis. This study investigated the effects of recombinant human milk fat globule-epidermal growth factor 8 on microthrombosis and neurological function after subarachnoid hemorrhage. METHODS: Rats subarachnoid hemorrhage model was induced by intravascular puncture method. Western blot was performed to measure the expression of endogenous milk fat globule-epidermal growth factor 8 after subarachnoid hemorrhage. Microthrombosis was quantified by microthrombi count using immunohistochemistry and immunofluorescence. The neuroprotective effect of recombinant human milk fat globule-epidermal growth factor 8 administration was evaluated by modified Garcia score, beam balance, Rotarod test, and Morris water maze. RESULTS: Endogenous milk fat globule-epidermal growth factor 8 protein level increased after subarachnoid hemorrhage. Microthrombosis was significantly increased in subarachnoid hemorrhage rats brain, while recombinant human milk fat globule-epidermal growth factor 8 dramatically reduced microthrombosis as well as improve short- and long- term neurobehavior after subarachnoid hemorrhage. CONCLUSIONS: Recombinant human milk fat globule-epidermal growth factor 8 reduces microthrombosis and improves neurological function after subarachnoid hemorrhage, which may be an effective strategy for treating subarachnoid hemorrhage.


Assuntos
Antígenos de Superfície/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Trombose Intracraniana/prevenção & controle , Proteínas do Leite/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Hemorragia Subaracnóidea/tratamento farmacológico , Animais , Antígenos de Superfície/metabolismo , Comportamento Animal/efeitos dos fármacos , Modelos Animais de Doenças , Trombose Intracraniana/sangue , Trombose Intracraniana/fisiopatologia , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Proteínas do Leite/metabolismo , Atividade Motora/efeitos dos fármacos , Equilíbrio Postural/efeitos dos fármacos , Ratos Sprague-Dawley , Proteínas Recombinantes/administração & dosagem , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/fisiopatologia , Fatores de Tempo
17.
Clin Chim Acta ; 500: 54-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626762

RESUMO

BACKGROUND: Oxidized low-density lipoprotein (ox-LDL) and its receptor, lectin-like ox-LDL receptor-1 (LOX-1) are involved in the pathogenesis of atherosclerosis. Expression of LOX-1 was substantially raised in the basilar arterial wall of subarachnoid hemorrhage (SAH) rabbits. We ascertained the relationship between serum soluble LOX-1 concentrations and functional outcome after human aneurysmal SAH. METHODS: We enrolled 94 aneurysmal SAH patients and 94 healthy controls. Serum soluble TOX-1 concentrations were quantified using commercial enzyme-linked immunosorbent assay kit. A poor outcome was defined as Glasgow outcome scale score of 1-3. RESULTS: Median values of serum soluble LOX-1 in stroke patients were significantly higher than those in controls (1.5 vs. 0.4 ng/ml, P < 0.001). Thirty patients (31.9%) had a poor outcome at 6 months after stroke. Serum soluble LOX-1 was a strong predictor of poor outcome (OR 5.20, 95% CI 1.25-22.04). Serum soluble LOX-1 concentrations exhibited a significant discriminatory capability (area under curve 0.811, 95% confidence interval 0.717-0.884). The predictive powers of World Federation of Neurological Surgeons grade, Hunt-Hess grade, modified Fisher grade, and serum soluble LOX-1 concentrations were comparable (all P > 0.05). CONCLUSIONS: Serum soluble LOX-1 appears to have the potential to become a promising prognostic predictor after human aneurysmal SAH.


Assuntos
Receptores Depuradores Classe E/sangue , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
18.
World Neurosurg ; 136: e24-e32, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31476464

RESUMO

OBJECTIVE: To retrospectively analyze the relationship between fibrinogen levels and outcomes in poor-grade aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We recruited 66 patients with poor-grade aSAH who were treated by neurosurgical clipping between January 2010 and December 2015. Serum samples were taken immediately on admission. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between fibrinogen levels and clinical outcomes. RESULTS: Nineteen men and 47 women were included; the average age was 57.2 years. The median of the admission serum fibrinogen level was 3.3 g/L. Of the 66 patients, 18 had died by 6 months after initial hemorrhage, whereas 48 patients survived. Multivariate analyses showed that Hunt and Hess grade V (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.06-14.20; P = 0.04) and admission serum fibrinogen level <2.5 g/L (OR, 6.15; 95% CI, 1.67-22.67; P = 0.006) were significantly associated with 6-month mortality. In addition, admission serum fibrinogen level was negatively correlated with delayed cerebral ischemia, and admission serum fibrinogen level <2.5 g/L (OR, 3.86; 95% CI, 0.99-15.09; P = 0.05) was also significantly associated with delayed cerebral ischemia. CONCLUSIONS: Patients with poor-grade aSAH with reduced admission fibrinogen level have a higher risk of delayed cerebral ischemia and 6-month mortality compared with those without. The admission serum fibrinogen level might be useful as a predictor and treatment target in patients with poor-grade sSAH who have undergone surgical treatment.


Assuntos
Fibrinogênio/análise , Hemorragia Subaracnóidea/mortalidade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Prognóstico , Estudos Retrospectivos , Hemorragia Subaracnóidea/sangue , Taxa de Sobrevida
19.
Neurosurgery ; 86(1): 122-131, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30850840

RESUMO

BACKGROUND: The relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, vasospasm, and clinical outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) are still unclear. OBJECTIVE: To identify the associations between admission Lp-PLA2 and vasospasm following subarachnoid hemorrhage and the clinical outcome of aSAH. METHODS: A total of 103 aSAH patients who had Lp-PLA2 level obtained within 24 h postbleeding were included. The relationships between Lp-PLA2 level, vasospasm, and clinical outcome were analyzed. RESULTS: Vasospasm was observed in 52 patients (50.49%). Patients with vasospasm had significantly higher Lp-PLA2 level than those without (P < .001). Both modified Fisher grade (P = .014) and Lp-PLA2 level (P < .001) were significant predictors associated with vasospasm. The Z test revealed that power of Lp-PLA2 was significantly higher than that of modified Fisher grade in predicting vasospasm (Z = 2.499, P = .012). At 6-mo follow-up, 44 patients (42.72%) had unfavorable outcome and 36 patients (34.95%) died. The World Federation of Neurosurgical Societies (WFNS) grade and Lp-PLA2 level were both significant predictors associated with 6-mo unfavorable outcome and mortality (all P < .001). The predictive values of Lp-PLA2 for unfavorable outcome and mortality at 6-mo tended to be lower than those of the WFNS grade, but the differences were not statistically significant (P = .366 and 0.115, respectively). Poor-grade patients having Lp-PLA2 > 200 µg/L had significantly worse 6-mo survival rate than poor-grade patients having Lp-PLA2 ≤ 200 µg/L (P = .001). CONCLUSION: The Lp-PLA2 might be useful as a novel predictor in aSAH patients. A total of 30 poor-grade patients; those with elevated Lp-PLA2 level have higher risk of 6-mo mortality compared to those without.


Assuntos
1-Alquil-2-acetilglicerofosfocolina Esterase/sangue , Admissão do Paciente/tendências , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/mortalidade , Vasoespasmo Intracraniano/sangue , Vasoespasmo Intracraniano/mortalidade , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Feminino , Seguimentos , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Resultado do Tratamento , Vasoespasmo Intracraniano/diagnóstico por imagem
20.
Neurotox Res ; 37(2): 397-405, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31267487

RESUMO

Inflammatory processes have long been implicated in the development of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). Macrophage migration inhibitory factor (MIF) has been implicated in inflammation. The aim of this study was to assess whether serum levels of MIF at admission helps to predict which patients with aSAH would subsequently develop DCI. All patients with first-ever aSAH admitted between 2016 and 2017 were considered for inclusion in this prospective study. Primary study outcome was development of DCI at discharge. Serum levels of MIF, C-reactive protein (CRP), and interleukin-6 (IL-6) were tested at admission. The relation of serum levels of MIF at admission with DCI was assessed by the logistic regression models. In this study, 201 patients were included. A correlation between Hunt and Hess score and serum levels of MIF was found (r = 0.340; P < 0.001). Fifty-two of the 201 aSAH (25.9%) were defined as DCI, and the obtained MIF level in those patients was higher than in those patients without DCI [26.4 (IQR, 22.6-32.4) ng/ml vs. 20.4 (16.4-24.6) ng/ml; P < 0.001). As a continuous variable, MIF was associated with the risk of DCI. When serum level of MIF was elevated by each 1 ng/ml, the unadjusted risk of DCI was increased by 18% (OR = 1.18 [1.12-1.25], P < 0.001), while the adjusted risk was increased by 10% (1.10 [1.03-1.19], P = 0.001). With the area under the curve (AUC) of 0.780 (95% CI, 0.710-0.849), the MIF showed a great discriminatory ability for DCI than CRP (0.665, 0.582-0.748; P < 0.001) and IL-6 (0.721, 0.642-0.799; P = 0.001). Interestingly, the combined model (MIF/IL-6/CRP) improved the MIF to predict DCI (AUC of the combined model: 0.811; 95% CI, 0.751-0.871; P = 0.024). Furthermore, inclusion of MIF in the existing risk factors for the prediction of DCI enhanced the index and net reclassification improvement (NRI) (P < 0.001) and integrated discrimination improvement (IDI) (P = 0.005) values, confirming the effective reclassification and discrimination. The data showed that elevated MIF serum level accurately identifies patients at highest risk for developing DCI following aSAH.


Assuntos
Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico por imagem , Oxirredutases Intramoleculares/sangue , Fatores Inibidores da Migração de Macrófagos/sangue , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/diagnóstico por imagem , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...