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Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

ABSTRACT: BACKGROUND: Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance. METHODS: A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria. RESULTS: Higher rebleeding rates were observed < 6 h after the initial aSAH (OR ?=?3.22, 95% CI ?=?1.46-7.12), and were associated with high systolic blood pressure (OR ?=?1.93, 95% CI ?=?1.31-2.83), poor Hunt-Hess grade (III-IV) (OR ?=?3.43, 95% CI ?=?2.33-5.05), intracerebral or intraventricular hematomas (OR ?=?1.65, 95% CI ?=?1.33-2.05), posterior circulation aneurysms (OR ?=?2.15, 95% CI ?=?1.32-3.49), and aneurysms >10 mm in size (OR ?=?1.70, 95% CI ?=?1.35-2.14). CONCLUSIONS: Aneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

SUBMITTER: Tang C

PROVIDER: S-EPMC4049799 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

Tang Chao C Zhang Tian-Song TS Zhou Liang-Fu LF

PloS one 20140609 6

<h4>Background</h4>Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance.<h4>Methods</h4>A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated f ...[more]

PMID: 24911172

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Project description:BackgroundPituitary dysfunction (PD) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). The prevalence of PD varies widely at a global level and no recent meta-analysis is available. Therefore, the aim of our systematic review and meta-analysis was to summarize the updated estimates of worldwide prevalence of PD after aSAH.MethodsScopus, Embase, Web of Science, and PubMed databases were used to comprehensively search the appropriate literature and a random-effects meta-analysis on the results of the available studies was performed. The heterogeneity in the prevalence estimates was evaluated by subgroup analysis in terms of types of PD, and acute and chronic phases of aSAH. The onset of PD within 6 months after aSAH was considered as acute, while that after 6 months was considered as chronic.ResultsTwenty-seven studies with 1848 patients were included in this analysis. The pooled prevalence of PD in the acute phase was 49.6% (95% CI, 32.4-66.8%), and 30.4% (95% CI, 21.4-39.4%) in the chronic phase. Among the hormonal deficiencies, growth hormone dysfunction was the most prevalent in the acute phase, being 36.0% (95% CI, 21.0-51.0%), while hypoadrenalism was the most prevalent in the chronic phase, being 21.0% (95% CI, 12.0-29.0%). Among the six World Health Organization regions, the South-East Asia Region has the highest prevalence of PD in the acute phase (81.0%, 95%CI, 77.0-86.0%, P < 0.001), while the European Region had the highest prevalence of PD in the chronic phase (33.0%, 95%CI, 24.0-43.0%, P < 0.001). Moreover, single pituitary hormonal dysfunction occurred more frequently than the multiple one, regardless of acute or chronic phase.ConclusionsAlmost half (49.6%) of the included patients with aSAH developed PD complication in the acute phase, while 30.4% of the patients developed them in the chronic phase. Although prevalence varies globally, the high healthcare burden, morbidity and mortality require greater awareness among clinicians.

Dataset Information

Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

Publications

Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

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