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What are the predictors of delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage? An up-to-date systematic review

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Abstract

Purpose

Delayed Cerebral Ischaemia (DCI) remains an important preventable driver of poor outcome in aneurysmal subarachnoid haemorrhage (aSAH). Our ability to predict DCI is based on historical patient cohorts, which use inconsistent definitions for DCI. In 2010, a definition of DCI was agreed upon and published by a group of aSAH experts. The aim of this study was to identify predictors using this agreed definition of DCI.

Methods

We conducted a literature search of Medline (PubMed) to identify articles published since the publication of the 2010 consensus definition. Risk factors and prediction models for DCI were included if they: (1) adjusted for confounding factors or were derived from randomised trials, (2) were derived from prospectively collected data and (3) included adults with aSAH. The strength of studies was assessed based on quality, risk of bias and applicability of studies using PROBAST.

Results

Eight studies totalling 4,542 patients were included from 105 relevant articles from 4,982 records. The most common reason for not including studies was failure to use the consensus definition of DCI (75%). No prediction models were identified in the eligible studies. Significant risk factors for DCI included the presence of onsite neuro-interventional services, high Neuropeptide Y, admission leucocytosis, neutrophil:lymphocyte >5.9 and Fisher Grade > 2. All studies had a high or unclear risk of bias.

Conclusions

Only a few studies with high risk of bias have investigated the predictors using consensus-defined DCI. Further studies are warranted to clarify risk factors of DCI in the modern era.

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Data availability

The data which supports the conclusions of this study is available from the corresponding author, HCP, upon reasonable request.

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Funding

HCP and LD are funded by the National Institute for Health Research Efficacy and Mechanism Evaluation Programme, Ref: 14/209/07. MH is supported by the Royal College of Surgeons England Research Fellowship and Brain Research UK.

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Author notes

  1. Caed Whittle and Milo A Hollingworth contributed equally to work.

Authors and Affiliations

  1. University of Nottingham Medical School, Nottingham, UK

    Caed Whittle

  2. Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK

    Milo A Hollingworth

  3. Department of Neurosurgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK

    Louise Dulhanty & Hiren C. Patel

Authors
  1. Caed Whittle
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  2. Milo A Hollingworth
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  3. Louise Dulhanty
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  4. Hiren C. Patel
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Contributions

All authors contributed to the study conception and design. The literature search, data analysis and writing the first draft of the manuscript were performed by Caed Whittle and Milo Hollingworth. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiren C. Patel.

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This study is a meta-analysis that reuses data from prior publications.

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This study is a meta-analysis which reuses published data from prior publications.

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The authors declare no competing interests.

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Supplementary information

ESM 1

Supplementary Material 1. The Differing Definitions used by Excluded Studies in a Systematic Review of DCI Risk Factors (DOCX 30 kb)

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Whittle, C., Hollingworth, M.A., Dulhanty, L. et al. What are the predictors of delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage? An up-to-date systematic review. Acta Neurochir 165, 3643–3650 (2023). https://doi.org/10.1007/s00701-023-05864-4

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  • DOI: https://doi.org/10.1007/s00701-023-05864-4

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