Cases Of Intracerebral Hemorrhage Research Articles

Death risk prediction model for patients with non-traumatic intracerebral hemorrhage

BackgroundThis study aimed to assess the risk of death from non-traumatic intracerebral hemorrhage (ICH) using a machine learning model.Methods1274 ICH patients who met the specified inclusion and exclusion criteria were analyzed retrospectively in the MIMIC IV 3.0 database. Patients were randomly divided into training, validation, and testing datasets in a ratio of 6:2:2 based on the outcome distribution. Data from the Second Hospital of Lanzhou University were used as an external validation set. This study used LASSO regression and multivariable logistic regression analysis to screen for features. We then employed XGBoost to construct a machine-learning model. The model’s performance was evaluated using ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score. Conclusively, the SHapley Additive exPlanations (SHAP) method was employed to interpret the model’s predictions.ResultsDeaths occurred in 572 out of the 1274 ICH cases included in the study, resulting in an incidence rate of 44.9%. The XGBoost model achieved a high AUC when predicting deaths in ICH patients (train: 0.814, 95%CI: 0.784 − 0.844; validation: 0.715, 95%CI: 0.653 − 0.777; test: 0.797, 95%CI: 0.743 − 0.851). The importance of SHAP variables in the model ranked from high to low was: ’GCS motor’, ’Age’, ’GCS eyes’, ’Low density lipoprotein (LDL)’, ’ Albumin’, ’ Atrial fibrillation’, and ’Gender’. The XGBoost model demonstrated good predictive performance in both the validation and external validation datasets.ConclusionsThe XGBoost machine learning model we built has demonstrated strong performance in predicting the risk of death from ICH. Furthermore, the SHAP provides the possibility of interpreting machine learning results.

Burden of Intracerebral Hemorrhage in Asia from 1990 to 2030: A Population-Based Study.

Intracerebral hemorrhage represents a critical subtype of stroke, imposing substantial social and economic challenges. Considering the considerable impact of intracerebral hemorrhage in Asia and the absence of studies detailing its epidemiological features, the aim of this study is to elucidate the temporal trends and distribution characteristics of intracerebral hemorrhage in Asia from 1990 to 2021, as well as to forecast the future burden. The data derived from Global Disease Burden Study 2021 were used to investigate the age-standardized rates and absolute numbers of incident intracerebral hemorrhage cases and related deaths in Asia across genders, age groups and geographical locations. Estimated annual percentage change was estimated to represent temporal trends and autoregressive integrated moving average model was used to forecast the future burden. In Asia, the age-standardized incidence and mortality rates of intracerebral hemorrhage per 100, 000 population have declined from 1990 to 2021, despite a continuous increase in the absolute numbers, which exhibit significant heterogeneity across different geographical locations. In terms of gender, males experience a greater burden of intracerebral hemorrhage compared to females, and the impact of risk factors on disability-adjusted life years of intracerebral hemorrhage varies. In comparison to the figures observed in 2021, our forecasts indicate a rise in the burden of intracerebral hemorrhage in Asia. The study offers an extensive depiction of the epidemiological features of intracerebral hemorrhage in Asia spanning from 1990 to 2021, while also outlining the diverse trajectories of the impending burden of this condition in the region. Comprehending the expected increase in disease burden can aid in formulating tailored strategies to tackle upcoming challenges.

Involvement of the posterior limb of the internal capsule independently predicts the prognosis of patients with basal ganglia and thalamic hemorrhage.

Intracerebral hemorrhage (ICH) is the most lethal and devastating subtype of stroke. Basal ganglia hemorrhage and thalamic hemorrhage are the most common types of ICH, accounting for 50-70% of all ICH cases, leading to disability and death, and it involves the posterior limb of the internal capsule to varying degrees. In this study, we investigated the impact of varying degrees of the involvement of the posterior limb of the internal capsule on the prognosis of patients with basal ganglia and thalamic ICH and assessed whether it improves the predictive accuracy of the max-ICH score, an existing scale for ICH functional outcome. This is a multicenter, retrospective, observational study. We graded the involvement of the posterior limb of the internal capsule according to the degree of compression and injury (called iICH, ranging from 0 to 4). An unfavorable outcome was defined as a 90-day modified Rankin Scale (mRS) of > 2. Multivariate logistic regression analysis was used to identify independent risk factors associated with unfavorable prognosis. The discrimination was verified using receiver operating characteristic curve (ROC) analysis, while the calibration was verified by the Hosmer-Lemeshow test. Of the 305 patients included, 188 from Nanfang Hospital were assigned to the development cohort, and 117 from Heyuan People's Hospital and Huadu District People's Hospital were assigned to the validation cohort. In the development cohort, iICH was identified as an independent factor of a 90-day unfavorable outcome, and the area under the ROC (AUC) was 0.774. When combined with the iICH, the AUC of max-ICH was significantly elevated from 0.816 to 0.866. Comparable results were found in the validation cohort. Increased involvement of the posterior limb of the internal capsule is associated with a worse outcome in patients with basal ganglia and thalamic ICH.

No clear relationship between circadian rhythm and cerebral perfusion parameters in pediatric and early adult populations.

Recent literature suggests circadian rhythm influences cerebral perfusion parameters in adults experiencing an acute large vessel occlusion, but this has never been investigated in the pediatric and young adult populations. We queried the United States RAPID Insights database (10/05/2018-09/29/2023) for unique patients between 2 and 25years with computed tomography perfusion (CTP). Included scans had a minimum ischemic core volume (rCBF <30%) of >0cc and a Tmax volume of >0cc. Intracerebral hemorrhage cases were excluded. Anterior circulation large vessel occlusion cases were segregated and reported separately. Imaging time was subdivided into three epochs: Night (23:00h-06:59h), Day (07:00h-14:59h), and Evening (15:00h-22:59h). Age was analyzed by pre-defined strata: 2-5, 6-11, 12-18, and 19-25years. Perfusion parameters were stratified by age and time epochs. We used non-parametric testing for variables with non-normal distributions. We included 2415 CTP scans, with 307 identified as LVO. There were 637 patients 18 or younger, with 85 LVOs. In the overall cohort, LVOs had higher penumbral volumes (75.0cc [25.0-156.0] vs 26.0cc [8.0-78.0], p<0.0001) and mismatch volumes (54.0cc [18.0-120.0] vs 21.0cc [7.0-62.0], p<0.0001). In the LVO subgroup, there was a trend towards higher mismatch volumes at night (58.0cc [IQR 19.5-139.8]) compared to evening (50.0cc [IQR 18.8-114.3]) or daytime (55.0cc [17.0-126.0]), but these differences were not significant (p=0.72). Contrary to reports in adults, we did not find a clear association between time of day and cerebral perfusion parameters among pediatric and young adult patients.

Immune Cells and Intracerebral Hemorrhage: A Causal Investigation Through Mendelian Randomization.

The involvement of immune cells in the pathophysiology of intracerebral hemorrhage (ICH) is becoming increasingly recognized, yet their specific causal contributions remain uncertain. The objective of this research is to uncover the potential causal interactions between diverse immune cells and ICH using Mendelian randomization (MR) analysis. Genetic variants associated with 731 immune cell traits were sourced from a comprehensive genome-wide association study (GWAS) involving 3757 participants. Summary statistics data for ICH were acquired from FinnGen, comprising 4056 ICH cases and 371,717 controls. The principal analytical tool utilized in our study was the inverse-variance weighted (IVW) method, incorporated as a key component of a two-sample MR approach. To mitigate potential biases and verify the stability of the conclusions drawn from the primary analytical methods, a series of sensitivity analyses were performed. MR analysis elucidated 33 immune cell traits with causal associations, comprising B cells (eight traits), conventional dendritic cells (cDC, two traits), maturation stages of T cells (two traits), monocytes (two traits), myeloid cells (five traits), TBNK cells (six traits), and regulatory T cells (Treg, eight traits). DP (CD4+CD8+) %T cell (OR=0.83, CI=0.72-0.96, p=0.013) exhibited the strongest protective effect. In contrast, transitional AC (OR=1.09, CI=1.02-1.16, p=0.006) and IgD- CD27- %lymphocyte (OR=1.08, CI=1.00-1.17, p=0.045) showed a higher tendency to increase the ICH risk. The sensitivity analyses validated the robustness and consistency of these results. Our research provides robust evidence substantiating the causal relationship between specific immunophenotypes and ICH risk. The identification of these findings significantly enhances our understanding of the pathogenic mechanisms underlying ICH, particularly pertaining to the immune system. This breakthrough paves the way for innovative clinical and pharmaceutical research opportunities, potentially promoting the development of targeted therapies and enhanced strategies for managing and preventing ICH.

Global, regional, and national burdens of intracerebral hemorrhage and its risk factors from 1990 to 2021.

The aim of this study was to assess the intracerebral hemorrhage (ICH) burden in 204 countries and territories worldwide from 1990 to 2021, disaggregated by sex, age, and sociodemographic index (SDI) at the global, regional, and country levels. Data from the 2021 Global Burden of Disease Study (GBD) were used to calculate age-standardized prevalence (ASPR), incidence (ASIR), death (ASDR), and disability-adjusted life year (DALY) rates for ICH. The estimated annual percentage change (EAPC) was used to assess time patterns. The Bayesian age-period-cohort (BAPC) model was employed to predict future ICH burden. In 2021, the global ICH burden remained high, with a total of 16.6 million cases and an ASPR of 194.51 cases per 100,000 people. The ASIR was 40.83 cases per 100,000 people, the ASDR was 39.09 cases per 100,000 people, and the age-standardized DALY rate was 923.64 per 100,000 people. The low-SDI regions had the highest ASPR, ASIR, ASDR, and DALY rates. Geographically, western sub-Saharan Africa had the highest ASPR, Central Asia had the highest ASIR, and Oceania had the highest ASDR and DALY rates. High systolic blood pressure was the leading risk factor for ICH death, contributing to 57.9% of global fatalities. Despite the decline in the ASIR, there is an ongoing increase in the absolute number of ICH cases, with significant differences observed across age, sex, region, country, and SDI. More attention and emphasis should be placed on improving the ICH burden in low-SDI areas.

Associated Factors of Long-Term Functional Outcome and Recovery Pattern After Intracerebral Hemorrhage: A Prospective Population-Based Study in Ulaanbaatar, Mongolia.

Long-term patterns of functional outcome after intracerebral hemorrhage (ICH) have not been well elucidated in population-based studies from low- and middle-income countries. The aim of this study was to define long-term functional outcomes, associated prognostic factors, and recovery patterns for patients with acute ICH. We conducted a prospective population-based stroke incidence study in Ulaanbaatar, Mongolia, with prospective follow-up. Multiple overlapping strategies were used to prospectively ascertain all strokes over 2 years. Patients were followed up at 28, 90, and 365 days. Associated factors of unfavorable outcome (defined as modified Rankin Scale scores, 3-6) and death at 365 days were identified using separate binary logistic regressions. Recovery pattern in terms of the proportions of patients with favorable outcomes (defined as modified Rankin Scale scores, 0-2) as the outcome was analyzed over time at 28, 90, and 365 days using generalized estimating equations with baseline covariates. A total of 1172 first-ever ICH cases were registered. Among these patients, 625 (56.4% of available modified Rankin Scale) cases had died and 853 (77.0%) had an unfavorable outcome at 365 days. The proportion of favorable outcomes increased from 12.1% at day 28 to 17.4% at day 90 and then to 23.0% at 1 year. Multivariable analysis revealed that older age, low socioeconomic status, absence of hypertension, hospital admission, neurosurgical intervention, and ICH severity, side, and intraventricular extension were independently associated with death/unfavorable outcome 365 days post-ICH. Most of these factors were also associated with the recovery pattern. The prognosis from ICH in low- and middle-income countries is dismal, with 56% of patients dead and 77% having an unfavorable functional outcome at 365 days, although there was a pattern of continuous recovery over this time period. These findings stress the importance of developing effective primary prevention and continuous active care for survivors to reduce the burden of ICH in low- and middle-income countries.

Infective endocarditis causing recurrent cerebral infarction, cerebral hemorrhage and septic meningitis: A case report.

We reported a rare case of recurrent cerebral infarction, intracerebral hemorrhage, and purulent meningitis, culminating in the diagnosis of a young patient with infective endocarditis who had been treated in 3 hospitals for a long course of illness for 8 months prior to diagnosis. It aims to enhance clinicians' understanding of the neurological complications caused by infective endocarditis. A 25-year-old male, student, was hospitalized for an 8-hour history of speech impairment and drooling with dysphagia. Magnetic resonance imaging (MRI) showed massive cerebral infarction in the right frontotemporal and insular lobes, and the first diagnosis was "cerebral infarction." Later, the patient developed recurrent cerebral infarction, intracerebral hemorrhage, and purulent meningitis. Recurrent cerebral infarction, intracerebral hemorrhage, and purulent meningitis were confirmed to be caused by infective endocarditis. The patient was treated with antiplatelet drugs such as aspirin and clopidogrel, mannitol to reduce intracranial pressure, and ceftriaxone and vancomycin to fight infection, and the patient's condition improved. The patient was diagnosed with infective endocarditis after 8 months without a clear diagnosis, and the patient was finally diagnosed with infective endocarditis during the final follow-up. Febrile patients should be aware of infective endocarditis, particularly if the fever is persistent of unknown origin or structural changes in the heart with neurologic lesions. Cardiogenic neurological diseases are relatively more severe, have a worse prognosis, and have a higher recurrence rate than primary neurological diseases, so early diagnosis and treatment are more urgently needed.

Hospitalization costs in patients with stroke in southeastern China: a retrospective population-based cohort study, 2019-2022.

Stroke remains a predominant cause of mortality and accounts for one-third of all stroke-related fatalities worldwide. Increasing expenses associated with stroke are a matter of significant concern; however, this aspect has been insufficiently examined. The purpose of this study was to analyze in-hospital stroke costs and explore potential factors influencing them across stroke subtypes. The records of stroke patients from 50 hospitals in southeastern China between 2019 and 2022 were reviewed using multistage stratified cluster random sampling. We focused on the cost patterns of four stroke types and used multivariate linear regression to identify cost determinants. A total of 417 (1.1%) patients had subarachnoid hemorrhage (SAH), 9309 (25.9%) had intracerebral hemorrhage (ICH), 22,248 (61.8%) had ischemic stroke (IS), and 4025 had transient ischemic attack (TIA). The number of stroke patients has sharply increased since the onset of COVID-19, with a majority of them being male (72.2%). Despite the fact that hospitalization costs are highest in tertiary hospitals (Chinese yuan [CNY] 30610.8/United States dollar [USD] 4551.0, interquartile range [IQR] 9944.9, 29668.4/1478.6, 4410.9), the majority of patients are admitted to tertiary hospitals (74.6%) or public hospitals (90.2%). Across all stroke subtypes, patients with SAH had the highest costs (CNY 93,454.9/USD13894.4, IQR 12273.2, 169920.0/1824.7, 25262.8), followed by those with ICH (CNY 48,724.2/USD 7244.0, IQR 16789.6, 57540.7/2496.2, 8554.8), IS (CNY 26,550.3/USD3947.4, IQR 8684.2, 28697.7/1291.1, 4266.6), and TIA (CNY 11,170.1/USD1660.7, IQR 6823.7, 12965.2/1014.5, 1927.6). Therapy fees comprised a significant portion of costs in ICH and IS cases (47.9% and 42.7%, respectively). Materials accounted for the highest proportion of expenses for SAH (56.1%), whereas patients with TIA spent more time on examinations (34.1%). Linear regression analysis revealed that length of stay (LOS), stroke subtype, hospital level, and stroke type were key factors influencing hospitalization costs. The visiting rate and charges were highest in tertiary public hospitals, and hospitalization costs were higher in hemorrhagic types of stroke than in ischemic types of stroke; the proportion of hospitalization cost categories varied among different types of stroke, with LOS, hospital type, and level substantially affecting hospitalization costs. Enhancing medical insurance reimbursement rates for hemorrhagic strokes, implementing a hierarchical medical system, tailoring cost categories to accommodate varying stroke subtypes, and shortening LOS may help alleviate the economic burden of stroke.

Application of detailed nursing management intervention in neurosurgical nursing.

In the contemporary healthcare environment, optimizing patient care strategies is of importance, particularly in neurosurgical environments. While traditional nursing methods have the foundation of patient care, there exists a growing recognition of the potential benefits of comprehensive nurse management. Despite this acknowledgment, there remains a gap in understanding the comparative effectiveness of comprehensive nurse management versus traditional approaches in reducing postoperative psychological stress, enhancing patient satisfaction, and promoting adherence in neurosurgical patients. This study compares the efficacy of comprehensive nurse management against traditional methods in facilitating the postoperative recovery of neurosurgical patients. Taking the traditional nursing management and detailed nursing management of neurosurgical patients in a municipal neurosurgical hospital from March 2021 to March 2022 as an example, the neurosurgery was divided into 50 patients in the detailed nursing management group and 50 patients in the traditional nursing management group. In the clear nursing management group, there were 50 patients, 20 male patients, with an average age of 58.7 ± 3.8 years, and 30 female patients, with an average age of 60.4 ± 4.3 years; In the traditional nursing management group, there were 50 patients, 26 male patients, with an average age of 59.7 ± 3.7 years, and 24 female patients, with an average age of 59.4 ± 3.9 years; Among the 100 patients, there were 60 cases of cerebral infarction, 25 cases of intracerebral hemorrhage and 15 cases of other neurosurgical diseases. Hundred neurosurgical patients were divided into two groups: comprehensive nursing management group and traditional nursing management group. The results showed that the comprehensive treatment effect of patients with detailed nursing management was better than that of the routine nursing group. At the same time, the complications were reduced, and the patient's satisfaction was higher. Through retrospective analysis and investigation of patients, this paper discusses the clinical application of a detailed nursing management model in neurosurgery, which can reduce the probability of infection and other complications and improve the quality of life and treatment effect of patients.

High-Volume Hospital Had Lower Mortality of Severe Intracerebral Hemorrhage Patients.

Intracerebral hemorrhage (ICH) accompanies higher mortality rates than other type of stroke. This study aimed to investigate the association between hospital volume and mortality for cases of ICH. We used nationwide data from 2013 to 2018 to compare high-volume hospitals (≥32 admissions/year) and low-volume hospitals (<32 admissions/year). We tracked patients' survival at 3-month, 1-year, 2-year, and 4-year endpoints. The survival of ICH patients was analyzed at 3-month, 1-year, 2-year, and 4-year endpoints using Kaplan-Meier survival analysis. Multivariable logistic regression analysis and Cox regression analysis were performed to determine predictive factors of poor outcomes at discharge and death. Among 9086 ICH patients who admitted to hospital during 18-month period, 6756 (74.4%) and 2330 (25.6%) patients were admitted to high-volume and low-volume hospitals. The mortality of total ICH patients was 18.25%, 23.87%, 27.88%, and 35.74% at the 3-month, 1-year, 2-year, and 4-year, respectively. In multivariate logistic analysis, high-volume hospitals had lower poor functional outcome at discharge than low-volume hospitals (odds ratio, 0.80; 95% confidence interval, 0.72-0.91; p<0.001). In the Cox analysis, high-volume hospitals had significantly lower 3-month, 1-year, 2-year, and 4-year mortality than low-volume hospitals (p<0.05). The poor outcome at discharge, short- and long-term mortality in ICH patients differed according to hospital volume. High-volume hospitals showed lower rates of mortality for ICH patients, particularly those with severe clinical status.

Prediction of the outcome of intracerebral hemorrhage by blood neutrophil to lymphocyte ratio: a prospective observational study.

Intracerebral haemorrhage (ICH) is defined as bleeding within the brain parenchyma. Neutrophil lymphocyte ratio (NLR) is a dynamic parameter that can be affected by an underlying condition like microangiopathy (e.g. hemorrhagic stroke). The NLR value at the time of stress (e.g. ICH) could be a predictor among various other factors on the outcome of the disease. The aim of this study is to see if NLR could be a predictor of the outcome of the ICH. This is a prospective observational study conducted in the Department of Neurosurgery and Department of Neurology, from March 2020 to February 2021. The ICH cases presented to the emergency department within 24h of symptoms were included. The baseline haematological and biochemical investigations were sent and the noncontrast computed tomography (NCCT) head was done for the diagnosis of ICH. The NLR was measured. The ICH volume was calculated by ABC/2. Follow-up of the patient to measure outcome was done with a modified Rankin scale (mRS) on 30 days. Student's t-test was used to correlate NLR-mRS. Fischer's exact test was used for a categorical association of NLR to mRS. A total of 89 patients with ICH were enrolled in this study. In this study, 62.92% of patients had good outcomes (NLR of 4.88±3.06), whereas 37.08% of patients had bad outcomes (NLR of 9.09± 4.92). Statistically, higher NLR was significantly predictive of poorer outcomes. ICH causes stress in the body, which alters the value of NLR. Components of NLR are altered after haemorrhage due to a change in homeostasis of brain parenchyma. The NLR value obtained at the time of emergency department visits may help to predict the 30 days outcome of ICH.

Abstract 058: Outcomes in Patients with Spontaneous Intracranial Hemorrhage Who Underwent Thromboelastography Testing

Introduction In the U.S., intracerebral hemorrhage (ICH) accounts for 10‐15% of all strokes, yet it carries a significantly higher risk of death or long‐term disability. While the Thromboelastography Platelet (TEG PM) mapping tool is well‐established for managing coagulopathy in trauma, organ transplantation, massive transfusions, and ECMO patients, its use in spontaneous ICH is not well understood. This study aims to evaluate patient outcomes in spontaneous ICH cases that received TEG testing compared to those that did not. Method Following IRB approval, we conducted a retrospective review of 215 patients with intracerebral hemorrhage (ICH) from June 2020 to June 2023. Out of these, 160 had spontaneous ICH, with 98 undergoing TEG‐PM testing and 62 not. The primary outcome was to evaluate the frequency of platelet transfusions and complications related to external ventricular drains (EVD). The secondary outcome was to compare discharge outcomes, using discharge status as a proxy for functional recovery, with discharge to home or acute rehab considered a good outcome. Chi‐square tests were performed to analyze differences between the TEG and non‐TEG groups, with all analyses conducted using IBM SPSS Statistics. Results We performed a Mann‐Whitney U test to compare ICH volume and initial National Institutes of Health Stroke Scale (NIHSS) scores between the two groups. The results showed that ICH volume was significantly lower in the non‐TEG‐PM group, with a p‐value of 0.002. The median ICH volume of TEG‐PM group was 13 (IQR 4.0‐36.0), while in non‐TEG‐PM group was 4.35 (IQR 1.0‐19.6). There was no significant difference in the initial NIHSS scores between the groups (p=0.063). In patients who underwent TEG‐PM, 10.2% received platelet transfusion as compared to non‐TEG‐PM group where 0% patients received platelet transfusion with p‐value of 0.009. In TEG‐PM group, 26.8 % patients had EVD placement vs 9.7 % in non‐TEG‐PM group with Odds Ratio 0.29 (0.11‐0.76). There was 1% EVD associated hemorrhage seen in patients of TEG‐PM group as compared to 0% in non‐TEG‐PM. 44.9% of the patients in the TEG‐PM had good discharge outcome as compared to 64.5% in non‐TEG‐PM group with p‐value of 0.1 Conclusion The data indicates that TEG‐PM testing is not a reliable predictor of patient outcomes in spontaneous ICH. Interestingly, patients who underwent TEG‐PM testing received more platelet transfusions compared to those who did not, but this did not impact the discharge outcomes. The ICH volume in both groups were not clinically significant.

Characteristics of Intracerebral Hemorrhage at Dr. Kariadi General Hospital: A Serial Case

Background: Stroke is an acute neurological deficit caused by sudden or rapid disruption of blood circulation to the brain. Intracerebral hemorrhage is the subtype of stroke with the highest mortality and disability rate. Several risk factors may be related to the clinical outcome of intracerebral hemorrhage. Herewith we present a case series regarding the characteristics of intracerebral hemorrhage. Methods: A case series among three intracerebral hemorrhage cases in January - February 2024 at Dr. Kariadi Hospital. Epidemiological, and clinical data were recorded and reported. Case Presentations: Three cases were studied, the main complaint of the patient was decreased consciousness. These patients had different risk factors for stroke. According to the Siriraj score, NIHSS score, and neuroimaging findings, these patients had hemorrhagic strokes with different brain lesions. Two-thirds of the patients had uncontrolled hypertension and one patient was accompanied by uncontrolled diabetes mellitus. Conclusion: Overall, all patients were &gt;45 years old and the risk factors of these patients were modified risk factors that is uncontrolled hypertension and diabetes mellitus over a long period resulting in ganglionic hemorrhage.

Association of aspirin use with risk of intracerebral hemorrhage in patients without history of stroke or transient ischemic attack in the UK Biobank.

The association between aspirin use and the risk of intracerebral hemorrhage (ICH) among individuals without previous stroke events is inconclusive. We investigated the association between regular aspirin use and ICH risk in middle-aged and older adults without previous stroke or transient ischemic attack (TIA). This prospective population-based study included participants older than 40 years with no history of stroke or TIA from the UK Biobank. The main exposure was regular aspirin use. Cox regression analyses and propensity score matching analyses estimated the hazard ratios (HRs) for aspirin use for incident fatal and non-fatal ICH. We conducted pre-specified subgroup analyses for selecting individuals at high risk of ICH when using aspirin. Multiple sensitivity analyses were performed to test the robustness of our results. A total of 449,325 participants were included into final analyses (median (IQR) age 58 (50-63) years, 54.6% females), of whom 58,045 reported aspirin use. During a median follow-up of 12.75 (IQR: 12.03-13.47) years, 1557 (0.3%) incident ICH cases were identified, of which 399 (25.6%) were fatal. Aspirin was not associated with increased risk of overall (hazard ratio (HR): 1.11, 95% confidence interval (CI): 0.95-1.27, P = 0.188), fatal (HR: 1.03, 95% CI: 0.78-1.36, P = 0.846) and non-fatal (HR: 1.12, 95% CI: 0.95-1.33, P = 0.186) ICH. Propensity score matching analysis showed similar results. Subgroup analysis indicated that aspirin use in individuals older than 65 years or with concurrent anticoagulant use was correlated with increased risk of ICH. In this large cohort study of middle-aged and older adults without stroke or TIA events, there was no significant association between aspirin use and ICH risk in the real-world setting. However, it is possible that aspirin use in those aged over 65 years and concurrent anticoagulant treatment may increase the risk of ICH.

Retracted: A Pre-Hospital Prediction Tool for Stroke Type Utilising Machine Learning Techniques

Abstract Background Stroke is a leading cause of death worldwide and leaves most survivors with permanent disability. 12.2 million people suffer strokes annually, of which 70% occur in low- and middle-income countries (LMIC). Stroke presents diagnostic challenges which limits access to effective, but time-sensitive, reperfusion therapies. Currently, stroke is diagnosed by the combination of clinical symptoms and signs and brain imaging. The aim of this study was to develop clinical prediction tools, for differentiating acute ischemic stroke (AIS) and intracerebral haemorrhage (ICH) in the pre-hospital setting without neuroimaging, utilising machine learning (ML). Methods We included 5349 patients with confirmed acute stroke who presented within 6 hours of symptom onset, from the INTERSTROKE case-control study. We compared predictions using six commonly used ML algorithms for classification i.e. multivariate logistic regression (MLR), k-nearest neighbour (KNN), support vector machine (SVM), neural networks (NN), random forests (RF), XGBoost. Algorithm inputs included medical history, symptoms and signs, and point-of-care blood tests, with an output of final diagnosis. Results The training cohort included 4280 patients with 3084 ischemic stroke and 1196 ICH cases, and the test cohort included 1069 patients with 771 ischemic stroke and 298 ICH cases. From 174 potential variables, we used univariate analyses to select 52 candidate variables for inclusion in the ML algorithms. These were selected based on their ability to predict (p &amp;lt; 0.20) stroke subtype. The AUCs in the test cohort for each of the ML classification models were: MLR 0.819, KNN 0.795, SVM 0.802, NN 0.814, RF 0.814, and XGBoost 0.807. Conclusion ML models showed great potential to predict stroke type at the prehospital stage and have comparable predictive abilities to previously developed ML prediction tools. This may facilitate point-of-care decisions and management of stroke in the pre-hospital setting in the future.

Epidemiology and Functional Outcome of Acute Stroke Patients in Korea using Nationwide data.

Korea's healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. 86,568 acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016 to 2021, focusing on acute subarachnoid hemorrhage, acute intracerebral hemorrhage, and acute ischemic stroke. Of these 86,568 patients, 8.3% was subarachnoid hemorrhage, 16.3% intracerebral hemorrhage, and 74.9% ischemic stroke. Trends showed decreasing subarachnoid hemorrhage and increasing intracerebral hemorrhage cases over the years. 68.3% stroke patients had the clear onset time. 49.6 % stroke patients arrived within 4.5 hours of symptom onset, with more treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of subarachnoid hemorrhage patients, 34.6% of intracerebral hemorrhage patients, and 63.8% of ischemic stroke patients. The results showed that ischemic stroke was the most common subtype, followed by intracerebral hemorrhage and subarachnoid hemorrhage. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and subarachnoid hemorrhage compared to intracerebral hemorrhage.

Bone marrow-derived mesenchymal stem cell-derived exosome-loaded miR-129-5p targets high-mobility group box 1 attenuates neurological-impairment after diabetic cerebral hemorrhage

BACKGROUND Diabetic intracerebral hemorrhage (ICH) is a serious complication of diabetes. The role and mechanism of bone marrow mesenchymal stem cell (BMSC)-derived exosomes (BMSC-exo) in neuroinflammation post-ICH in patients with diabetes are unknown. In this study, we investigated the regulation of BMSC-exo on hyperglycemia-induced neuroinflammation. AIM To study the mechanism of BMSC-exo on nerve function damage after diabetes complicated with cerebral hemorrhage. METHODS BMSC-exo were isolated from mouse BMSC media. This was followed by transfection with microRNA-129-5p (miR-129-5p). BMSC-exo or miR-129-5p-overexpressing BMSC-exo were intravitreally injected into a diabetes mouse model with ICH for in vivo analyses and were cocultured with high glucose-affected BV2 cells for in vitro analyses. The dual luciferase test and RNA immunoprecipitation test verified the targeted binding relationship between miR-129-5p and high-mobility group box 1 (HMGB1). Quantitative polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay were conducted to assess the levels of some inflammation factors, such as HMGB1, interleukin 6, interleukin 1β, toll-like receptor 4, and tumor necrosis factor α. Brain water content, neural function deficit score, and Evans blue were used to measure the neural function of mice. RESULTS Our findings indicated that BMSC-exo can promote neuroinflammation and functional recovery. MicroRNA chip analysis of BMSC-exo identified miR-129-5p as the specific microRNA with a protective role in neuroinflammation. Overexpression of miR-129-5p in BMSC-exo reduced the inflammatory response and neurological impairment in comorbid diabetes and ICH cases. Furthermore, we found that miR-129-5p had a targeted binding relationship with HMGB1 mRNA. CONCLUSION We demonstrated that BMSC-exo can reduce the inflammatory response after ICH with diabetes, thereby improving the neurological function of the brain.

Bone marrow-derived mesenchymal stem cell-derived exosome-loaded miR-129-5p targets high-mobility group box 1 attenuates neurological-impairment after diabetic cerebral hemorrhage.

Diabetic intracerebral hemorrhage (ICH) is a serious complication of diabetes. The role and mechanism of bone marrow mesenchymal stem cell (BMSC)-derived exosomes (BMSC-exo) in neuroinflammation post-ICH in patients with diabetes are unknown. In this study, we investigated the regulation of BMSC-exo on hyperglycemia-induced neuroinflammation. To study the mechanism of BMSC-exo on nerve function damage after diabetes complicated with cerebral hemorrhage. BMSC-exo were isolated from mouse BMSC media. This was followed by transfection with microRNA-129-5p (miR-129-5p). BMSC-exo or miR-129-5p-overexpressing BMSC-exo were intravitreally injected into a diabetes mouse model with ICH for in vivo analyses and were cocultured with high glucose-affected BV2 cells for in vitro analyses. The dual luciferase test and RNA immunoprecipitation test verified the targeted binding relationship between miR-129-5p and high-mobility group box 1 (HMGB1). Quantitative polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay were conducted to assess the levels of some inflammation factors, such as HMGB1, interleukin 6, interleukin 1β, toll-like receptor 4, and tumor necrosis factor α. Brain water content, neural function deficit score, and Evans blue were used to measure the neural function of mice. Our findings indicated that BMSC-exo can promote neuroinflammation and functional recovery. MicroRNA chip analysis of BMSC-exo identified miR-129-5p as the specific microRNA with a protective role in neuroinflammation. Overexpression of miR-129-5p in BMSC-exo reduced the inflammatory response and neurological impairment in comorbid diabetes and ICH cases. Furthermore, we found that miR-129-5p had a targeted binding relationship with HMGB1 mRNA. We demonstrated that BMSC-exo can reduce the inflammatory response after ICH with diabetes, thereby improving the neurological function of the brain.

The relationship between HbA1c and the activities of daily living in complex chronic patients with and without intracerebral hemorrhage

BackgroundAssociations between HbA1c and adverse outcomes in ischemic and hemorrhagic stroke have been confirmed. It is still unclear whether HbA1c is related to the activities of daily living (ADL) score in complex chronic patients (CCP) with and without intracerebral hemorrhage (ICH).AimThe associations between HbA1c and ADL (Barthel score) in CCP with ICH and without ICH were evaluated, respectively.MethodsWe have analyzed data from a previous cohort study involving in 3594 CCPs without a ICH history at baseline, who were followed up for 5 years to assess ICH episode.ResultsOne hundred sixty-one ICH case were detected in a total of 3594 patients during the period of follow up for 5 years. Our nonlinear analysis suggested positive trends on the association between HBA1c and Barthel score in ICH and non-ICH patients, respectively. The multivariate linear regression analysis showed that elevated HbA1c was positively associated with a higher Barthel score among all study population (β = 1.25, 95% CI: 0.92, 1.59; P < 0.0001) with adjusted age and sex. Among non-ICH patients, increased HbA1c was still positively associated with an increased Barthel score (β = 1.24, 95% CI: 0.90, 1.58; P < 0.001). However, HbA1c appeared to have no any relationship with Barthel score in ICH patients (β = 1.87, 95% CI: -0.07, 3.82; P = 0.0613) after adjustment for age and sex. By additionally using sensitivity analysis, we still observed that the strong relationship was still existed in non-ICH patients (β = 0.90, 95% CI: 0.56, 1.24; P < 0.001) but not in ICH patients (β = 1.88, 95% CI: -0.10, 3.86; P = 0.0649).ConclusionWe observed for the first time that elevated HbA1c is associated with better ADL in CCPs without ICH but not in those with ICH. This interesting discovery contradicts the traditional adverse effects of elevated HbA1c.