Abstract
Iron and its derivatives play a significant role in various physiological and biochemical pathways, and are influenced by a wide variety of inflammatory, infectious, and immunological disorders. We hypothesized that iron and its related factors play a role in intracranial aneurysm pathophysiology and investigated if serum iron values are associated with ruptured intracranial aneurysms. 4,701 patients with 6,411 intracranial aneurysms, including 1201 prospective patients, who were diagnosed at the Massachusetts General Hospital and Brigham and Women’s Hospital between 1990 and 2016 were evaluated. A total of 366 patients with available serum iron, ferritin and total iron binding capacity (TIBC) values were ultimately included in the analysis. 89% of included patients had anemia. Patients were categorized into ruptured and non-ruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the association between ruptured aneurysms and iron, ferritin, and TIBC. TIBC values (10−3 g/L) within 1 year of diagnosis (OR 0.41, 95% CI 0.28–0.59) and between 1 and 3 years from diagnosis (OR 0.52, 95% CI 0.29–0.93) were significantly and inversely associated with intracranial aneurysm rupture. In contrast, serum iron and ferritin were not significant. In this case-control study, low TIBC was significantly associated with ruptured aneurysms, both in the short- and long term. However, this association may not apply to the general population as there may be a selection bias as iron studies were done in a subset of patients only.
Highlights
Www.nature.com/scientificreports aneurysm rupture is unknown[7,8,9,10,11]
With a combination of machine learning algorithms and manual chart review, we identified 4,701 patients who were diagnosed with an intracranial aneurysm at the Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH) between 1990 and 201612
We obtained an initial set of potential aneurysm patients from the Research Patients Data Registry (RPDR) with the use of ICD-9 and CPT codes, and we used natural language processing (NLP) to train a classification algorithm which yielded 5,589 patients12. 727 of these patients were seen on clinical presentation from 2007–2013 with prospectively collected data[14]
Summary
Www.nature.com/scientificreports aneurysm rupture is unknown[7,8,9,10,11]. We present a case-control study investigating the magnitude and direction of the association between rupture of intracranial aneurysms and iron values and its reactive derivatives. In order to control for the effects of acute-phase reactions after aneurysm rupture, we included both short-term and long-term measurements. The associations found in this study may be influenced by selection bias as iron studies were performed only in a subset of patients
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