Abstract：
BACKGROUND: Predictors of delayed cerebral infarction (DCI) and early cerebral infraction (ECI) among aneurysmal subarachnoid hemorrhage (aSAH) patients remain unclear. We aimed to systematically review and synthesize the literature on predictors of ECI and DCI among aSAH patients.
METHODS: We systematically searched PubMed, EMBASE, Cochrane Library, and Scopus databases comprehensively from inception through January 2024 for observational cohort studies examining predictors of DCI or ECI following aneurysmal SAH. Studies were screened, reviewed, and meta-analyzed, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. The data were pooled as Odds ratios (OR) with 95% confidence intervals using Review Manager 5.4 software. Methodologic quality was assessed with the Newcastle-Ottawa Scale.
RESULTS: Our meta-analysis included 12 moderate to high-quality cohort studies comprising 4527 patients. Regarding DCI predictors, Higher severity scores (OR = 1.49, 95% confidence interval [1.12, 1.97], P = 0.005) and high Fisher scores (OR = 2.23, 95% confidence interval [1.28, 3.89], P = 0.005) on presentation were significantly associated with an increased risk of DCI. Also, the female sex and the presence of vasospasm were significantly associated with an increased risk of DCI (OR = 3.04, 95% confidence interval [1.35, 6.88], P = 0.007). In contrast, preexisting hypertension (P = 0.94), aneurysm treatment (P = 0.14), and location (P = 0.16) did not reliably predict DCI risk. Regarding ECI, the pooled analysis demonstrated no significant associations between sex (P = 0.51), pre-existing hypertension (P = 0.63), severity (P = 0.51), or anterior aneurysm location versus posterior (P = 0.86) and the occurrence of ECI.
CONCLUSIONS: Female sex, admission disease severity, presence of vasospasm and Fisher grading can predict DCI risk post-aSAH. Significant knowledge gaps exist for ECI predictors. Further large standardized cohorts are warranted to guide prognosis and interventions.
METHODS: We systematically searched PubMed, EMBASE, Cochrane Library, and Scopus databases comprehensively from inception through January 2024 for observational cohort studies examining predictors of DCI or ECI following aneurysmal SAH. Studies were screened, reviewed, and meta-analyzed, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. The data were pooled as Odds ratios (OR) with 95% confidence intervals using Review Manager 5.4 software. Methodologic quality was assessed with the Newcastle-Ottawa Scale.
RESULTS: Our meta-analysis included 12 moderate to high-quality cohort studies comprising 4527 patients. Regarding DCI predictors, Higher severity scores (OR = 1.49, 95% confidence interval [1.12, 1.97], P = 0.005) and high Fisher scores (OR = 2.23, 95% confidence interval [1.28, 3.89], P = 0.005) on presentation were significantly associated with an increased risk of DCI. Also, the female sex and the presence of vasospasm were significantly associated with an increased risk of DCI (OR = 3.04, 95% confidence interval [1.35, 6.88], P = 0.007). In contrast, preexisting hypertension (P = 0.94), aneurysm treatment (P = 0.14), and location (P = 0.16) did not reliably predict DCI risk. Regarding ECI, the pooled analysis demonstrated no significant associations between sex (P = 0.51), pre-existing hypertension (P = 0.63), severity (P = 0.51), or anterior aneurysm location versus posterior (P = 0.86) and the occurrence of ECI.
CONCLUSIONS: Female sex, admission disease severity, presence of vasospasm and Fisher grading can predict DCI risk post-aSAH. Significant knowledge gaps exist for ECI predictors. Further large standardized cohorts are warranted to guide prognosis and interventions.
摘要：
背景：动脉瘤性蛛网膜下腔出血（aSAH）患者迟发性脑梗死（DCI）和早期脑梗死（ECI）的预测因素尚不清楚。我们旨在系统回顾和综合有关aSAH患者中ECI和DCI预测因子的文献。
方法：我们系统地搜索了PubMed，EMBASE,科克伦图书馆,和Scopus数据库从开始到2024年1月全面用于观察性队列研究,检查动脉瘤性SAH后DCI或ECI的预测因素.研究进行了筛选，reviewed,并进行了荟萃分析，坚持PRISMA和Cochrane准则。使用RevMan5.4软件将数据合并为具有95%置信区间(CI)的赔率比(OR)。用纽卡斯尔-渥太华量表评估方法学质量。
结果：我们的荟萃分析包括12项中等至高质量的队列研究，包括4527名患者。关于DCI预测因子，更高的严重程度评分（O.R.=1.49，95CI[1.12，1.97]，P=0.005）和高Fisher分数（O.R.=2.23，95CI[1.28,3.89]，P=0.005)与DCI风险增加显著相关。此外，女性和血管痉挛的存在与DCI风险增加显著相关(O.R.=3.04,95CI[1.35,6.88],P=0.007)。相比之下,先前存在的高血压（p=0.94），动脉瘤治疗（p=0.14），和位置(p=0.16)不能可靠地预测DCI风险。关于ECI，汇总分析表明性别之间没有显著关联(P=0.51)，预先存在的高血压（P=0.63），严重性（P=0.51），或前动脉瘤位置与后动脉瘤位置（P=0.86）和ECI的发生。
结论：女性性别，入院疾病严重程度，血管痉挛的存在和Fisher分级可以预测aSAH后的DCI风险。ECI预测因子存在显著的知识差距。需要进一步的大型标准化队列来指导预后和干预。
方法：我们系统地搜索了PubMed，EMBASE,科克伦图书馆,和Scopus数据库从开始到2024年1月全面用于观察性队列研究,检查动脉瘤性SAH后DCI或ECI的预测因素.研究进行了筛选，reviewed,并进行了荟萃分析，坚持PRISMA和Cochrane准则。使用RevMan5.4软件将数据合并为具有95%置信区间(CI)的赔率比(OR)。用纽卡斯尔-渥太华量表评估方法学质量。
结果：我们的荟萃分析包括12项中等至高质量的队列研究，包括4527名患者。关于DCI预测因子，更高的严重程度评分（O.R.=1.49，95CI[1.12，1.97]，P=0.005）和高Fisher分数（O.R.=2.23，95CI[1.28,3.89]，P=0.005)与DCI风险增加显著相关。此外，女性和血管痉挛的存在与DCI风险增加显著相关(O.R.=3.04,95CI[1.35,6.88],P=0.007)。相比之下,先前存在的高血压（p=0.94），动脉瘤治疗（p=0.14），和位置(p=0.16)不能可靠地预测DCI风险。关于ECI，汇总分析表明性别之间没有显著关联(P=0.51)，预先存在的高血压（P=0.63），严重性（P=0.51），或前动脉瘤位置与后动脉瘤位置（P=0.86）和ECI的发生。
结论：女性性别，入院疾病严重程度，血管痉挛的存在和Fisher分级可以预测aSAH后的DCI风险。ECI预测因子存在显著的知识差距。需要进一步的大型标准化队列来指导预后和干预。
