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Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis

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Abstract

Background and purpose

It remains inconclusive whether asymptomatic intracranial hemorrhage (aICH) after acute ischemic stroke is innocuous. We aimed to conduct a meta-analysis assessing the relationship between the aICH and poor neurological outcomes.

Methods

We searched PubMed, EMBASE and Web of Science from their inception to 30 November 2021 and performed a meta-analysis on the association between the aICH and neurological prognosis after acute ischemic stroke at 3 months, including poor outcomes (modified Rankin Scale [mRS] score ≥ 2 or mRS ≥ 3) and mortality.

Results

Fourteen studies were included in the analysis, reporting on a total of 10,915 participants after acute ischemic stroke. The risks of poor outcome (mRS ≥ 2 or mRS ≥ 3) in patients with aICH were significantly higher than patients without ICH (OR 1.70, 95% CI 1.33–2.18; OR 1.43, 95% CI 1.20–1.70, respectively), based on adjusted data. The difference between the two groups was not significant for mortality. The results of subgroup analysis showed aICH were associated with higher ratio of mild poor prognosis (mRS ≥ 2) (OR 1.59, 95% CI 1.11–2.27), but it had no association with functional dependence (mRS ≥ 3) after recanalization. No significant influence of aICH on poor outcome (mRS ≥ 3) was found in non-recanalization group. Further stratified analysis revealed that only aICH with patients receiving endovascular therapy (EVT) could increase the risk of mild poor prognosis (mRS ≥ 2) at 3 months.

Conclusions

Our results indicate that compared with patients without ICH, those who developed aICH during the acute stage of ischemic stroke had an increasing risk of worse outcome, especially in patients with endovascular therapy.

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Funding

This work was funded by the National Natural Science Foundation of China (82071292, 81601004, and 81102248), Kelin New Talent Program (R08016), the Natural Science Foundation of Guangdong Province (2016A030310139), the Fundamental Research Funds for the Central Universities(20ykpy66), Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases(2020B1212060017), Guangdong Provincial Clinical Research Center for Neurological Diseases (2020B1111170002), the Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases (2015B050501003 and 2020A0505020004), Guangdong Provincial Engineering Center for Major Neurological Disease Treatment, and Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease.

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  1. Guoyi Tang and Zhixin Cao contributed equally.

Authors and Affiliations

  1. Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Zhixin Cao, Yuting Luo & Xunsha Sun

  2. Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Guoyi Tang & Shaoqing Wu

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  1. Guoyi Tang
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Correspondence to Shaoqing Wu or Xunsha Sun.

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Tang, G., Cao, Z., Luo, Y. et al. Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis. J Neurol 269, 3470–3481 (2022). https://doi.org/10.1007/s00415-022-11046-6

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