scholarly journals Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage

2017 ◽  
Vol 126 (2) ◽  
pp. 586-595 ◽  
Author(s):  
Christopher D. Wilson ◽  
Sam Safavi-Abbasi ◽  
Hai Sun ◽  
M. Yashar S. Kalani ◽  
Yan D. Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Factor ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Level Of Evidence ◽  
Fisher Grade ◽  
Shunt Dependency

OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) may be complicated by hydrocephalus in 6.5%–67% of cases. Some patients with aSAH develop shunt dependency, which is often managed by ventriculoperitoneal shunt placement. The objectives of this study were to review published risk factors for shunt dependency in patients with aSAH, determine the level of evidence for each factor, and calculate the magnitude of each risk factor to better guide patient management. METHODS The authors searched PubMed and MEDLINE databases for Level A and Level B articles published through December 31, 2014, that describe factors affecting shunt dependency after aSAH and performed a systematic review and meta-analysis, stratifying the existing data according to level of evidence. RESULTS On the basis of the results of the meta-analysis, risk factors for shunt dependency included high Fisher grade (OR 7.74, 95% CI 4.47–13.41), acute hydrocephalus (OR 5.67, 95% CI 3.96–8.12), in-hospital complications (OR 4.91, 95% CI 2.79–8.64), presence of intraventricular blood (OR 3.93, 95% CI 2.80–5.52), high Hunt and Hess Scale score (OR 3.25, 95% CI 2.51–4.21), rehemorrhage (OR 2.21, 95% CI 1.24–3.95), posterior circulation location of the aneurysm (OR 1.85, 95% CI 1.35–2.53), and age ≥ 60 years (OR 1.81, 95% CI 1.50–2.19). The only risk factor included in the meta-analysis that did not reach statistical significance was female sex (OR 1.13, 95% CI 0.77–1.65). CONCLUSIONS The authors identified several risk factors for shunt dependency in aSAH patients that help predict which patients are likely to require a permanent shunt. Although some of these risk factors are not independent of each other, this information assists clinicians in identifying at-risk patients and managing their treatment.

scholarly journals Risk Factors for Re-bleeding of Aneurysmal Subarachnoid Hemorrhage: Systemic Review and Meta Analysis

2014 ◽  
Vol 21 (1) ◽  
pp. 113-123
Author(s):  
Alfotih Gobran Taha ◽  
Fang Cheng Li ◽  
Xin Ke Xu ◽  
Shang Yi Zhang
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Subarachnoid Hemorrhage ◽  
Clinical Condition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Systemic Review ◽  
High Systolic Blood Pressure ◽  
Aneurysm Size ◽  
Fisher Grade

Abstract Objective : The mortality of re-bleeding is high and patients surviving are usually in poor clinical condition and have a worse outcome than patients with single bleed. We performed an update systemic review and Meta-analysis to determine the most common risk factors for re-bleeding in aneurysmal subarachnoid hemorrhage patients. Method: We reviewed all publications on the risk factors of the re-bleeding or rerupture of already bled intracranial aneurysms. This Meta analysis included studies published from the year 2000 until 2013. Pooled mean difference was calculated for the continuous variables (Age), and pooled odds ratio (OR) was calculated for categorical factors. Heterogeneity was tested first. If it is significant (p<0.05), random effect model was applied, otherwise, fixed model was used. Software - Review manager was used to find pooled effects and perform significant test for each potential risk factor. Results : We identified 174 articles. Only 7 retrospective studies had met the inclusion criteria, with 2470 patients, 283 patients had aneurysmal re-bleeding. The weighted average rate of re-bleeding is 11.3% with 95% confidence interval [CI]: 10.1-12.6. Statistically significant risk factor for re-bleeding were sex (OR 1.46; 95% CI: 1.11, 1.92), high systolic blood pressure [SBP] (OR 2.52; 95% CI: 1.40, 4.53), aneurysm size (OR 3.00; 95% CI: 2.06- 4.37), clinical condition (Hunt & Hess) (OR 4.94; 95% CI: 2.29, 10.68), and Fisher Grade (OR 2.29; 95% CI: 1.45, 3.61). Conclusion: Sex, high SBP, high Fisher Grade, aneurysm size larger than 10 mm, and patients with poor clinical condition (Hunt & Hess) were independent risk factors for aneurysmal re-bleeding. The importance of early aneurysm intervention should be emphasized to eliminate the risk of re-bleeding and poor outcome.

Abstract WMP58: Sex Differences in Risk Factors for Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Sabah Rehman ◽  
Berhe Sahle ◽  
Ronil V Chandra ◽  
Amanda G Thrift ◽  
Michele Callisaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Sex Differences ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis

Abstract WP237: Risk Factors for Aneurysmal Subarachnoid Hemorrhage in Women: Systematic Review and Meta-Analysis

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Sabah Rehman ◽  
Berhe Sahle ◽  
Ronil V Chandra ◽  
Amanda G Thrift ◽  
Michele Callisaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis

scholarly journals Defining Optimal Dosing of Nimodipine in Aneurysmal Subarachnoid Hemorrhage: Study Protocol for a Systematic Review

2020 ◽  
Author(s):  
judith bellapart ◽  
Kevin B Laupland ◽  
Eva Malacova ◽  
Jeffrey Lipman ◽  
Jason A Roberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Data Extraction ◽  
Meta Analysis ◽  
Future Research ◽  
Level Of Evidence ◽  
Optimal Dosing ◽  
Clinical Scenarios

Abstract Background: Nimodipine has been first line prophylaxis of cerebral vasospasm after subarachnoid hemorrhage for more than three decades, but its level of evidence has become controversial and essential questions regarding its pharmacological properties and its precise mechanism of action remain unclear. The level of evidence for Nimodipine was established in times when subarachnoid hemorrhage patients had their aneurysm secured in a delayed phase and when intravascular coiling was not established, these two clinical scenarios differ from current practice questioning the applicability of its therapeutic regimen. This review aims to investigate the strength of nimodipine as a prophylaxis for cerebral vasospasm within a contemporary context and to propose pathways for future research in nimodipine. Methods: We will search electronic databases including Medline, Embase, Cochrane, Web of Science and PubMed using a defined search strategy. Two authors will independently rate the quality of the searched evidence using the Chalmers scale for the scoring of studies ‘quality. Discrepancies will be assessed by a third independent author. All studies will be described in a table of studies’ characteristics and data extraction completed. Meta-analysis will be performed if there are two or greater homogeneous outcomes that suffices for reporting on measures of variability. Discussion: The results rising from this systematic review may guide further clinical trials focused on nimodipine dosing with the view of optimizing therapy for better neurological outcomes.Systematic review registration: PROSPERO ID = CRD42020188319

scholarly journals Incidence and risk factors of delirium after percutaneous coronary intervention in individuals hospitalised for acute myocardial infarction: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044564
Author(s):  
Kaizhuang Huang ◽  
Jiaying Lu ◽  
Yaoli Zhu ◽  
Tao Cheng ◽  
Dahao Du ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Risk Factor ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cochrane Library ◽  
Percutaneous Coronary

IntroductionDelirium in the postoperative period is a wide-reaching problem that affects important clinical outcomes. The incidence and risk factors of delirium in individuals with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI) has not been completely determined and no relevant systematic review and meta-analysis of incidence or risk factors exists. Hence, we aim to conduct a systematic review and meta-analysis to ascertain the incidence and risk factors of delirium among AMI patients undergoing PCI.Methods and analysesWe will undertake a comprehensive literature search among PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL and Google Scholar from their inception to the search date. Prospective cohort and cross-sectional studies that described the incidence or at least one risk factor of delirium will be eligible for inclusion. The primary outcome will be the incidence of postoperative delirium. The quality of included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence and risk factors associated with delirium will be extracted. Incidence data will be pooled. Each risk factor reported in the included studies will be recorded together with its statistical significance; narrative and meta-analytical approaches will be employed. The systematic review and meta-analysis will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence and risk factors of delirium after PCI among patients with AMI, which is necessary for future research in this area. The findings of this study will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020184388.

RISK OF SHUNT-DEPENDENT HYDROCEPHALUS AFTER OCCLUSION OF RUPTURED INTRACRANIAL ANEURYSMS BY SURGICAL CLIPPING OR ENDOVASCULAR COILING

Neurosurgery ◽  
2007 ◽  
Vol 61 (5) ◽  
pp. 924-934 ◽  
Author(s):  
Jean G. de Oliveira ◽  
Jürgen Beck ◽  
Matthias Setzer ◽  
Rüdiger Gerlach ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intraventricular Hemorrhage ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Long Term Outcome ◽  
Acute Hydrocephalus ◽  
Angiographic Vasospasm ◽  
Fisher Grade ◽  
Shunt Dependency ◽  
Ruptured Intracranial Aneurysms

Abstract OBJECTIVE To compare the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by clipping versus coiling. METHODS We analyzed 596 patients prospectively added to our database from July of 1999 to November of 2005 concerning the risk of shunt dependency after clipping versus coiling. Factors analyzed included age; sex; Hunt and Hess grade; Fisher grade; acute hydrocephalus; intraventricular hemorrhage; angiographic vasospasm; and number, size, and location of aneurysms. In addition, a meta-analysis of available data from the literature was performed identifying four studies with quantitative data on the frequency of clip, coil, and shunt dependency. RESULTS The institutional series revealed Hunt and Hess grade, Fisher grade, acute hydrocephalus, intraventricular hemorrhage, and angiographic vasospasm as significant (P &lt; 0.05) risk factors for shunt dependency after a univariate analysis. In a multivariate logistic regression analysis, we isolated intraventricular hemorrhage, acute hydrocephalus, and angiographic vasospasm as independent, significant risk factors for shunt dependency. The meta-analysis, including the current data, revealed a significantly higher risk for shunt dependency after coiling than after clipping (P = 0.01). CONCLUSION Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.

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