Evidence map›Paper›PMID 36470246›Full record

ArticleJournal of stroke2023

Cerebral Edema in Patients with severe Hemispheric Syndrome: Incidence, Risk Factors, and Outcomes-Data from SITS-ISTR.

Irene Escudero-Martínez, Magnus Thorén, Peter Ringleb, Ana Paiva Nunes, Manuel Cappellari, Viiu-Marika Rand, Piotr Sobolewski, Jose Egido, Danilo Toni, Shih-Yin Chen and 2 more

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In one paragraph

Article in Journal of stroke, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.6field-weighted citation impact, top 31% 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

5 citing papers in PubMed, 5 citations in OpenAlex.

  1. Trial
  2. Article
  3. Article
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  5. 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

12 authors at 11 institutions in 8 countries.

Irene Escudero-MartínezDepartment of Neurology, University Hospital La FE, Valencia, Spain.
Magnus ThorénDepartment of Neurology, Danderyd Hospital, Stockholm, Sweden.
Peter RinglebDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Ana Paiva NunesDepartment of Neurology, Sao Jose Hospital, University Hospital Lisboa, Lisboa, Portugal.
Manuel CappellariDepartment of Neuroscience, Integrate University Hospital, Verona, Italy.
Viiu-Marika RandDepartment of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia.
Piotr SobolewskiDepartment of Neurology and Stroke Unit in Sandomierz, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland.
Jose EgidoStroke Unit, Department of Neurology, San Carlos Clinic Hospital, Madrid, Spain.
Danilo ToniDepartment of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Shih-Yin ChenBiogen, Cambridge, MA, USA.
Nicole TsaoBiogen, Cambridge, MA, USA.
Niaz AhmedDepartment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Biogen (United States) · USDanderyds sjukhus · SEHeidelberg University · DEHospital Clínico San Carlos · ESHospital de São José · PTHospital Universitari i Politècnic La Fe · ESJan Kochanowski University · PLKarolinska University Hospital · SENorth Estonia Medical Centre · EESapienza University of Rome · ITUniversity of Verona · IT

Funding

Boehringer-IngelheimFriends of Karolinska InstitutetKarolinska InstitutetStockholm County CouncilSwedish HeartLung FoundationSwedish Order of St. John
6 · The paper itself

Abstract

background and purposeCerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia.

methodsOservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003-2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0-2) and death at 90 days.

resultsPatients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age <50 years (relative risk [RR], 1.56), signs of acute infarct (RR, 1.29), hyperdense artery sign (RR, 1.39), blood glucose >128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02).

conclusionsIn patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.

Indexed as

Brain edemaCerebral hemorrhageRegistriesReperfusionThrombectomyThrombolytic therapy

Identifiers

PMID36470246
PMCPMC9911855
OpenAlexW4310782931

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

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.