Leveraging machine learning algorithms to forecast delayed cerebral ischemia following subarachnoid hemorrhage: a systematic review and meta-analysis of 5,115 participants

Neurosurgical Review, Год журнала: 2025, Номер 48(1)

Опубликована: Янв. 7, 2025

Язык: Английский

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Effectiveness of human albumin for clinical outcome in aneurysmal subarachnoid hemorrhages: a protocol for randomized controlled (HASH) trial

Trials, Год журнала: 2025, Номер 26(1)

Опубликована: Фев. 14, 2025

Aneurysmal subarachnoid hemorrhage (aSAH) is a dreadful acute neurological condition with an overwhelmingly high rate of associated morbidities and mortality. Despite leaping advancement in neurosurgical techniques imaging modalities, there no substantiative improvement the overall prognosis for aSAH. Cerebral vasospasm remains predominant cause morbidities. Human albumin has been used different conditions, including head trauma, intracerebral hemorrhages, ischemic strokes, favorable outcomes. However, its beneficial use aSAH not sufficiently explored until recently published systematic review by our team. In view scarcity data lack robust evidence, group designed first-ever RCT to compare human albumin-enhanced fluid management versus standard therapy crystalloids patients This single-center open-label, prospective, parallel randomized control trial will be conducted at Hamad General Hospital, Doha, Qatar, from August 2024 July 2027. A sample size 84 (42 each arm) calculated sufficient detect clinically significant difference modified Rankin scale good score between two groups (human-albumin induced volume expansion crystalloid only) aneurysmal patients. The primary outcome based on dichotomized [good grades (0–2) poor (3–6)], while secondary include symptomatic vasospasm, transcranial Doppler velocities, Pulse index Contour Cardiac Output (PiCCO) parameters. aims provide firsthand evidence achieve optimal regime explore potential role improving clinical outcomes ClinicalTrials.gov NCT06548477. Registered 9, 2024. https://clinicaltrials.gov/search?term=NCT06548477 .

Язык: Английский

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Anaesthesia for clipping of intracranial aneurysms

BJA Education, Год журнала: 2025, Номер unknown

Опубликована: Май 1, 2025

Язык: Английский

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Systemic Metabolic Alterations after Aneurysmal Subarachnoid Hemorrhage: A Plasma Metabolomics Approach

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown

Опубликована: Янв. 7, 2025

Aneurysmal subarachnoid hemorrhage (aSAH) causes systemic changes that contribute to delayed cerebral ischemia (DCI) and morbidity. Circulating metabolites reflecting underlying pathophysiological mechanisms warrant investigation as biomarker candidates. Blood samples, prospectively collected within 24 hours (T1) of admission 7-days (T2) post ictus, from patients with acute aSAH two tertiary care centers were retrospectively analyzed. Samples healthy subjects non-neurologic critical illness served controls. A validated external analysis platform was used perform untargeted metabolomics. Bioinformatics analyses conducted identify metabolomic profiles defining each group delineate metabolic pathways altered in group. Machine learning (ML) models developed incorporating key improve DCI prediction. Among 70 aSAH, 30 control, 17 sick control subjects, a total 1,117 detected. Groups matched among clinical variables. occurred 36% poor functional outcome observed 70% at discharge. Metabolomic readily discriminated the groups. demonstrated robust mobilization lipid metabolites, increased levels free fatty acids (FFAs), mono- diacylglycerols (MAG, DAG) compared both also had decreased circulating amino acid derived consistent catabolism. associated sphingolipids (sphingosine sphinganine) acylcarnitines S- adenosylhomocysteine T1. Decreased lysophospholipids outcomes. Incorporating into ML improved prediction variables alone. Profound shifts occur after characteristic increases decreases metabolites. Key outcomes (sphingolipids, lysophospholipids, acylcarnitines) provide insight driving secondary complications. These may prove be useful biomarkers prognostication personalize care.

Язык: Английский

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Magnesium as an adjunct to nimodipine in subarachnoid hemorrhage: a meta-analysis

Journal of Yeungnam Medical Science, Год журнала: 2025, Номер 42, С. 26 - 26

Опубликована: Фев. 2, 2025

Background: Subarachnoid hemorrhage (SAH) is a devastating neurological condition with high morbidity and mortality rates. Although nimodipine widely used in the management of SAH, potential benefits magnesium as adjunct therapy remain unclear. This meta-analysis aimed to evaluate efficacy safety combining for SAH.Methods: A comprehensive literature search was conducted using PubMed, ScienceDirect, Google Scholar, Cochrane Library. Randomized controlled trials prospective cohort studies comparing plus versus alone patients SAH were included. Key outcomes included cerebral vasospasm (CV), delayed ischemia (DCI), functional outcomes, mortality, adverse events.Results: Twelve involving 2,338 The combination significantly reduced incidence CV (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29–0.95; <i>p</i>=0.03) DCI (OR, 0.52; CI, 0.31–0.87; <i>p</i>=0.01) compared alone. However, no significant differences found (modified Rankin Scale: OR, 0.97; <i>p</i>=0.75; Glasgow Outcome 0.81; p=0.24), <i>p</i>=0.83), or secondary infarction 0.38; <i>p</i>=0.12). events higher group; however, this difference not statistically 3.14; <i>p</i>=0.33).Conclusion: Adding may help reduce but does improve mortality. Further large-scale are needed optimize dosing regimens confirm these findings.

Язык: Английский

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Predictive modeling of aneurysmal subarachnoid hemorrhage with acute lung injury complicating delayed cerebral ischaemia

Frontiers in Neurology, Год журнала: 2025, Номер 16

Опубликована: Март 12, 2025

Objective Delayed cerebral ischemia (DCI) is a frequent consequence of aneurysmal subarachnoid hemorrhage (aSAH), and severe aSAH typically accompanied with Acute Lung Injury (ALI). This research examined the risk variables for delayed ischaemia in patients complicated ALI, developed columnar graph prediction model. Methods Clinical data from 234 admitted to Lishui People’s Hospital between January 2018 June 2024, were analyzed. The randomly divided into training group (164 cases) validation (70 cases). Risk factors occurrence identified incorporated model, differentiation reliability line model validated via use ROC curves calibration curves. Results Multifactorial logistic regression three significant independent DCI: elevated positive end-expiratory pressure (PEEP), interleukin-6, D-dimer ( p &lt; 0.05). column-line plots demonstrated superior discriminatory performance both set (AUC = 0.882, 95% CI: 0.820–0.940) 0.874, 0.778–0.996), while indicated strong concordance sets. Conclusion High pressure, d-dimer are DCI aSHA combined resulting graphs show predictive value help better identify at high DCI.

Язык: Английский

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Systematic review and meta-analysis of transcranial doppler biomarkers for the prediction of delayed cerebral ischemia following subarachnoid hemorrhage

Journal of Cerebral Blood Flow & Metabolism, Год журнала: 2025, Номер unknown

Опубликована: Март 20, 2025

Delayed cerebral ischemia (DCI) following an aneurysmal subarachnoid hemorrhage (aSAH) significantly impacts mortality, morbidity, and healthcare costs. This study assessed the diagnostic accuracy of Transcranial Doppler (TCD)-derived biomarkers for predicting DCI via a systematic review meta-analysis. Included studies had to correctly define report data on sensitivity, specificity, positive predictive value, negative value. Univariate or bivariate analyses with random effects model were used, risk bias was evaluated Quality Assessment Diagnostic Accuracy Studies. From 23 eligible articles (n = 2371 patients), three biomarker categories identified: blood flow velocities (CBFV), autoregulation, microembolic signals (MES). The highest sensitivity (0.86, 95% CI 0.71–0.94) specificity (0.75, 0.52–0.94) prediction achieved mean CBFV 120 cm/s combined Lindegaard ratio. transient hyperemic response test showed best performance among autoregulatory 0.88, (95% 0.54–0.98) 0.82 0.52–0.94). MES less effective predictors. Combining enhanced TCD’s High heterogeneity noted, indicating need standardized TCD approach improved evaluation.

Язык: Английский

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CTA image segmentation method for intracranial aneurysms based on MGLIA net

Scientific Reports, Год журнала: 2025, Номер 15(1)

Опубликована: Март 27, 2025

Accurately segmenting the aneurysm area from CTA data can reconstruct three-dimensional morphology of aneurysm, effectively evaluating type, size, and risk rupture aneurysm. However, accurate separation is limited by accuracy image segmentation algorithms. Currently, methods for intracranial aneurysms using big deep learning lack universality. When faced with a new hospital acquired imaging modality, it usually necessary to redesign train network. In response this issue, article proposes more universal model develops GLIA Net algorithm (MGLIA model) based on MoblieNet, which perform adaptive target images collected under different conditions. To verify effectiveness in segmentation, performance tests were conducted an open-source dataset. The results showed that proposed achieved 55.9% 73.1% two datasets, respectively, significantly better than original GLIA-Net algorithm.

Язык: Английский

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MiR-34c Is Predictive of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Апрель 1, 2025

Introduction Delayed cerebral ischemia (DCI) is a potentially preventable complication from an aneurysmal subarachnoid hemorrhage (SAH). The micro-RNAs (miR) 34 family has shown its ability to disrupt the blood-brain barrier and redox metabolism might contribute complex pathophysiology of DCI. This study aimsto evaluate association between serum levels miR-34c occurrence Methods retrospective observational based on 72 subjects with acute SAH who were admitted single tertiary center December 2017 July 2021. Subjects prospectively adjudicated for clinical outcomes, including delayed ischemia.Levels measured in plasma collected within 48 hours ictus. Patients median-dichotomized into having higher or lower level miR-34c. miR34c compared DCI no groups using Wilcoxon rank sum tests. A multivariable logistic regression model Cox proportional hazard used effect levels. Results median age was 54 years, 76% females, 21% developed Early significantly progressed have Cohen's d 0.75 (p<0.05). Even after adjusting age, sex, histories diabetes, hypertension, Hunt-Hess grade, modified Graeb scores, associated 5.7-fold increased odds (p<0.05; 95% CI: 1.35-32.22). Survival analysis known predictors also revealeda 5.4-fold patients (p < 0.05; CI 1.22-25.43). Conclusion present demonstrates potential importance circulating predicting patients. Given miR-34 vascular physiology, it may be important target future studies.

Язык: Английский

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Effects of metformin use on aneurysmal subarachnoid hemorrhage outcomes

Acta Neurochirurgica, Год журнала: 2025, Номер 167(1)

Опубликована: Апрель 10, 2025

Abstract Background Metformin is widely prescribed and has neuroprotective effects in animals, but its impact on brain injury after aneurysmal subarachnoid hemorrhage (aSAH) humans unclear. Methods This single-center retrospective review assessed patients with aSAH from 2009 to 2023, categorizing them based pre-admission metformin use. The primary outcome was delayed cerebral ischemia (DCI), while secondary outcomes included in-hospital mortality, rebleeding, angiographic vasospasm (CVS), favorable modified Rankin Scale (mRS) scores at discharge the 3-month follow-up. Outcomes were analyzed using logistic regression. Sensitivity analysis performed excluding receiving comfort care. Results A total of 900 (47 853 non-metformin). DCI rates similar between groups (38.3% vs. 29.3%, aOR = 1.06 [0.49–2.28]). Rebleeding 4.3% for users 5.6% non-users (aOR 0.47 [0.09–2.51]). In-hospital mortality 9.7% [0.08–2.84]). Angiographic CVS 38.3% 52.8% 0.49 [0.23–1.05]), 7 days, 29.8% 47.6% 0.46 [0.21–1.01]). showed (39.1% 30.9%, 0.98 [0.45–2.15]) lower days 0.44 [0.20–0.98]). Conclusion use before did not significantly affect risk or CVS. However, care patients, findings are highly speculative reduced post-aSAH. across groups. Future research larger, multi-institutional datasets needed better understand metformin's impact, particularly during aSAH.

Язык: Английский

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