Evidence map›Paper›PMID 34850332›Full record

ArticleNeurocritical care2022

Early Fevers and Elevated Neutrophil-to-Lymphocyte Ratio are Associated with Repeat Endovascular Interventions for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage.

Ehsan Dowlati, William Mualem, Austin Carpenter, Jason J Chang, Daniel R Felbaum, Samir Sur, Ai-Hsi Liu, Jeffrey C Mai, Rocco A Armonda

Abstract read
PubMed Publisher
In one paragraph

Article in Neurocritical care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.1field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Systemic Inflammation after Aneurysmal Subarachnoid Hemorrhage.International journal of molecular sciences · 2023
    Review
  5. Article
  6. Review
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Ehsan Dowlati *Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA. edowlati@gmail.com.ORCID http://orcid.org/0000-0001-6739-0793
William Mualem *School of Medicine, Georgetown University, Washington, DC, USA.
Austin CarpenterDepartment of Neurosurgery, New York Medical College, Valhalla, NY, USA.
Jason J ChangDepartment of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Daniel R FelbaumDepartment of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.
Samir SurDepartment of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.
Ai-Hsi LiuDepartment of Radiology, MedStar Washington Hospital Center, Washington, DC, USA.
Jeffrey C MaiDepartment of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.
Rocco A ArmondaDepartment of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.
MedStar Washington Hospital Center · USGeorgetown University · USNew York Medical College · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) may develop refractory arterial cerebral vasospasm requiring multiple endovascular interventions. The aim of our study is to evaluate variables associated with need for repeat endovascular treatments in refractory vasospasm and to identify differences in outcomes following one versus multiple treatments.

methodsWe retrospectively reviewed patients treated for aSAH between 2017 and 2020 at two tertiary care centers. We included patients who underwent treatment (intraarterial infusion of vasodilatory agents or mechanical angioplasty) for radiographically diagnosed vasospasm in our analysis. Patients were divided into those who underwent single treatment versus those who underwent multiple endovascular treatments for vasospasm.

resultsOf the total 418 patients with aSAH, 151 (45.9%) underwent endovascular intervention for vasospasm. Of 151 patients, 95 (62.9%) underwent a single treatment and 56 (37.1%) underwent two or more treatments. Patients were more likely to undergo multiple endovascular treatments if they had a Hunt-Hess score > 2 (odds ratio [OR] 5.10 [95% confidence interval (CI) 1.82-15.84]; p = 0.003), a neutrophil-to-lymphocyte ratio > 8.0 (OR 3.19 [95% CI 1.40-7.62]; p = 0.028), and more than two fevers within the first 5 days of admission (OR 7.03 [95% CI 2.68-20.94]; p < 0.001). Patients with multiple treatments had poorer outcomes, including increased length of stay, delayed cerebral ischemia, in-hospital complications, and higher modified Rankin scores at discharge.

conclusionsA Hunt-Hess score > 2, a neutrophil-to-lymphocyte ratio > 8.0, and early fevers may be predictive of need for multiple endovascular interventions in refractory cerebral vasospasm after aSAH. These patients have poorer functional outcomes at discharge and higher rates of in-hospital complications.

Indexed as

Subarachnoid HemorrhageVasospasm, IntracranialFeverHumansLymphocytesNeutrophilsRetrospective StudiesTreatment OutcomeAneurysmAngioplastyFeverNeutrophil-to-lymphocyte ratioSubarachnoid hemorrhageVasodilatory agentsVasospasm

Identifiers

PMID34850332
OpenAlexW3216307607

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.