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Cerebral Microbleeds are Associated with Higher Mortality Among Ischemic Stroke Patients
Ramin Zand1, Shima Shahjouei2, Georgios Tsivgoulis3
1Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania.
Background:
Several studies have shown that cerebral microbleeds (CMBs) increase the risk of long-term stroke-related mortality. The purpose of this study was to determine if the existence and burden of CMBs are a predictor of in-hospital death among patients with acute ischemic stroke (AIS).
Methods:
We studied consecutive ischemic stroke patients who admitted to our tertiary center over a 2-year period (2013-2014). Patients who underwent thrombolysis were excluded. Baseline characteristics of patients, number and topography of CMBs, white matter lesions, and spontaneous symptomatic hemorrhagic transformation were recorded. Outcome measure in our study was in-hospital death.
Results:
Out of 1126 consecutive AIS patients evaluated in this study, 772 patients included in the study (mean age 61.9 ± 14.2years [18-95 years], 51.6% men, and 58.2% African American). CMBs were present on the magnetic resonance imaging (MRI) sequences of 124 (16.1%) patients. The overall rate of in-hospital mortality was 4.1%. The presence or absence of CMBs was not predictive of in-hospital mortality (P = .058). After adjusting for potential confounders, the presence of ≥4 CMBs on T2*-weighted MRI was independently (P = .004) associated with a higher likelihood of in-hospital death (odds ratio: 6.6, 95% confidential interval: 2.50 and 17.46) in multivariable logistic regression analyses. Older age, higher National Institute of Health stroke scale, and history of atrial fibrillation were also associated with greater chance of in-hospital death.
Conclusions:
The presence or absence of CMBs was not predictive of in-hospital mortality. However, the presence of multiple CMBs was associated with a higher in-hospital mortality rate among AIS patients.
Insights
Cerebral microbleeds (CMBs) do not predict in-hospital death in acute ischemic stroke (AIS) patients. However, multiple CMBs identified on MRI are linked to increased in-hospital mortality risk.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Cerebral microbleeds (CMBs) are associated with increased long-term stroke mortality.
- Predicting in-hospital death in acute ischemic stroke (AIS) patients is crucial for timely intervention.
Purpose of the Study:
- To investigate if the presence and burden of CMBs predict in-hospital death in AIS patients.
- To evaluate CMBs as a prognostic marker for acute stroke outcomes.
Main Methods:
- Retrospective analysis of 772 AIS patients admitted between 2013-2014, excluding those who received thrombolysis.
- Recorded patient demographics, CMB count and location, white matter lesions, and hemorrhagic transformation.
- In-hospital death was the primary outcome measure.
Main Results:
- CMBs were present in 16.1% of AIS patients; overall in-hospital mortality was 4.1%.
- The mere presence of CMBs did not predict in-hospital death (P=0.058).
- However, ≥4 CMBs on T2*-weighted MRI independently predicted higher in-hospital death risk (OR 6.6, P=0.004), alongside older age, NIHSS, and atrial fibrillation.
Conclusions:
- The presence or absence of cerebral microbleeds is not a predictor of in-hospital mortality in acute ischemic stroke.
- A higher burden of multiple cerebral microbleeds is significantly associated with increased in-hospital mortality risk in AIS patients.
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