Publicaciones

Long-term vascular events after subarachnoid hemorrhage

Fernandez-Perez I, Giralt-Steinhauer E, Cuadrado-Godia E, Guimaraens L et al. J Neurol. 2022 Nov;269(11):6036-6042. doi: 10.1007/s00415-022-11255-z. Epub 2022 Jul 20. PMID: 35854138
Abstract:
Background: Spontaneous subarachnoid hemorrhage (SAH) long-term risk is not well known. Our aims are: describing long-term vascular event (VE) incidence rates in SAH survivors; describing VE: ischemic and/or hemorrhagic; identifying independent association of factors related to VE; and analyzing the usefulness of factors to increase predictive ability.
Methods: A prospective cohort study of consecutive patients admitted to Hospital del Mar with a diagnosis of SAH (n=566) between January 2007 and January 2020 was carried out. They were followed up until January 2021. The study endpoint was a new VE in the follow-up. We calculated both incidence rates and cumulative rates at 5 years. Cox regression survival models including vascular risk factors with and without specifc data of SAH disease were developed. We analyzed ROC curves of all multivariate models.
Results: The analyzed cohort included 423 non-fatal SAH cases. Total patient-years were 2468.16 years. The average followup was 70.03±43.14; range: 1–180 months. There were 49 VE detected in 47 patients, as 2 of them had more than 1 VE. Incidence rate was 0.020 events_per_patient/year, cumulative incidence at 5 years was 11.11%. The more frequent VE that we found were cerebrovascular (28/49), mainly ischemic (21/28). Disability after SAH and the presence of multiple aneurysms were independently associated with a VE risk and improved the predictive capacity of multivariate models (AUC 0.679 vs 0.764; p=0.0062).
Conclusions We reported a low vascular risk after SAH. We have shown the usefulness of SAH factors to identify patients with a higher risk of VE.
Funding: Supported in part by Spain’s Ministry of Health; FEDER, RICORDS-ICTUS(RD21/0006/0021) and PIO19/00011.

Analysis of the prognostic value of emergency blood tests in ischaemic stroke

Marta-Enguita J, Rubio-Baines I, Aymerich N, Herrera M et al. Neurologia (Engl Ed). 2022 Nov 17:S2173-5808(22)00176-6. doi: 10.1016/j.nrleng.2022.03.007. Online ahead of print. PMID: 36402398
Abstract. Objectives: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke.
Methods: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. Results: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy.
Funding: This study was funded by the Instituto Carlos III Healthcare Research Fund (PI19/00065), the Biomedical Research Network for Cardiovascular Diseases (CIBERCV; CB16/11/00371), and the Network for Cooperative Research in Health Outcomes for Cerebrovascular Diseases (RICORS; RD21/0006/0008).