Characteristics and outcomes of stroke hospitalizations in patients with sickle cell disease and moyamoya syndrome |
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| Affiliation: | 1. Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, 10 Plum Street, Fifth Floor, New Brunswick, NJ, USA 08901;2. Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205;1. Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Road, Yuzhong District, Chongqing 400010, China;2. Department of Neurology, Army Medical Center of PLA, No.10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China;1. Department of Neurosurgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyusyu-City, Fukuoka 802-0001, Japan;2. Department of Neurology, Kokura Memorial Hospital, Fukuoka, Japan;1. Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China;2. Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China;1. Psychiatrist, University of Belgrade, Faculty of Medicine, Laza Lazarevi? Hospital of Psychiatry, Faculty of Medicine, Belgrade, Serbia;2. Associate Researcher of Radiology, University of Belgrade, Faculty of Medicine, Sveti Sava Hospital, Department of CT and MRI, Belgrade, Serbia;3. Professor of Neurology, University of Belgrade, Faculty of Medicine, Clinical Center, Clinic of Neurology;4. Assistant Professor of Radiology, Military Medical Academy, Institute of Radiology, Belgrade, Serbia;5. Hematologist, University of Belgrade, Clinical Hospital Center Bezanijska Kosa, Department of Hematology, Belgrade, Serbia;6. Neurologist, Clinical Neuroscience, Neurology, Helsinki University Central Hospital, University of Helsinki, Finland;7. Teaching Assistant in Dermatovenerology, University of Belgrade, Media Group Hospital, Belgrade, Serbia;8. Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia;9. Associate Professor of Anatomy, University of Belgrade, Faculty of Veterinary Medicine, Institute of Anatomy, Belgrade, Serbia;10. Professor of Neuroanatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Department of Neuroanatomy, Belgrade, Serbia;1. Division of Neurocritical Care, Massachusetts General Hospital, 55 Fruit Street, Lunder 644, Boston, MA 02114, USA;2. Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA;3. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA;4. Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women''s Hospital, Boston, MA, USA;5. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA |
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| Abstract: | Objectives: Stroke is the leading cause of death in patients with Sickle cell disease (SCD). Here, we detail the burden of Moyamoya syndrome (MMS) as a cause of stroke in patients with SCD.Materials and Methods: A review of SCD-related hospital discharges was conducted utilizing the National Inpatient Sample. Rates of stroke hospitalization, risk factors, procedures, and outcomes were compared between patients with SCD-MMS and SCD alone. Univariate analyses including T-test, Wilcoxon Rank-Sum test, Chi-square were performed to compare risk factors and outcomes. Multivariable regression was used to identify predictors of stroke unique to each population.Results: Stroke occurred in 9.8% of SCD-MMS hospitalizations versus 0.5% of those involving patients with SCD alone (OR = 20.71, p < 0.001). Patients with SCD-MMS developed stroke at younger ages and with fewer comorbidities compared to those with SCD alone. Stroke hospitalizations in SCD-MMS involved a greater number of procedures (90.5% vs. 79.3%, p = 0.007), but were more likely to result in favorable discharge (58.5% vs. 44.2%, p = 0.005). The presence of anemia during hospitalization was a significant risk factor for stroke in both cohorts. Long-term antiplatelet use was protective against stroke (OR = 0.42, p = 0.008) only in the SCD-MMS cohort.Conclusions: MMS confers a 20-fold increased risk of stroke among patients with SCD and appears to be an important cause of recurrent stroke in this population. Anemia is one of the most significant risk factors for stroke, while antiplatelet use appears to confer a protective benefit. |
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