Lifetime Prevalence of Stroke within an Adult Population with Sickle Cell Disease: A Cross-Sectional Study
Notice bibliographique
Résumé
Background Stroke is a potentially devastating complication among patients with sickle cell disease (SCD). Stroke has been well described in children with SCD and can now be prevented in most cases through early screening by transcranial doppler and intensification of treatment for those at risk. In adult patients with SCD, systematic data on stroke prevalence, etiology, and long-term functional impacts are limited. The primary goal of this study was to determine the lifetime prevalence of stroke within an adult population with SCD followed in a specialized referral centre. Secondary objectives included stratification by stroke type, etiology, treatment received and functional outcome. Methods The study was designed as a retrospective cross-sectional study that quantified the prevalence of stroke at the end of the observation period (December 2023 or at the last visit) in a large monocentric cohort. All adult patients (≥18 years old) with any SCD genotype (HbSS, HbS β°/β+-thalassemia and HbSC), that had at least one visit between 2011 and 2023 at CHUM were included. Patients were evaluated by vascular neurologists in a specialized clinic in which standard assessment included a National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Montreal Cognitive Assessment (MoCA) test. Symptomatic stroke was defined as any cerebral infarction or intracranial hemorrhage on brain imaging with a corresponding focal neurological deficit or related symptoms. Clinical patient characteristics were extracted from the electronic medical record. Summary statistics were calculated as mean (standard deviation), median [range] and proportions, as appropriate. The project was approved by the local ethics committee. Results Overall, 450 patients met the inclusion criteria, 258 (57%) of which were women. The median age was 32 years [range 18-79]. Genotypes included 215 patients with HbSS (48%), 10 HbSβ0 (2%), 190 HbSC (42%) and 35 HbSβ+ (8%). Sixteen patients (3.6%) were identified with at least one symptomatic stroke (median age at presentation 36 years [range 4-65]), including 10 (2.2%) with cerebral infarction (median age 25 years [range 4-58], 6 (1.3%) with intracranial hemorrhage (median age 45 years [range 20-65]). For the SS/Sβ0 and SC/Sβ+ genotypes, stroke prevalence was 9/225 (4.0%) and 7/225 (3.1%), respectively. Three patients (0.7%) suffered at least one recurrent stroke during follow-up. Etiologies for ischemic strokes included carotid stenosis (n=1), Moya-Moya syndrome (n=1), cardio-embolic origin (n=3), acute vaso-occlusive crisis (n=2) and unknown etiology (n=3). Underlying causes for intracranial hemorrhage included aneurysm rupture (n=5) and underlying severe microangiopathy (n=1). Acute hematological treatment included blood transfusions within 24 hours of admission for 3 patients. None received acute reperfusion therapy (including IV thrombolysis or mechanical thrombectomy). Aneurysms were treated by endovascular (n=4) or neurosurgical procedures (n= 1). Thirteen patients began long-term exchange transfusions, 10 antiplatelet therapy, and 2 oral anticoagulants. On the last follow-up, nine stroke patients had residual neurological deficits with a median NIHSS score of 0 [range 0-9] and a median mRS of 2 [range 0-3]; seven patients were unable to work. Patients after stroke had a median MoCA of 20 [range 11-29]; 11 had MoCA scores below 26. Discussion This large cross-sectional study confirms that the lifetime prevalence of symptomatic stroke in adults with SCD is high with at times long term functional impairment. Stroke etiologies include intracranial large vessel disease, but also common causes such as underlying carotid stenosis or cardiac embolism. Studies with longitudinal neurovascular follow-up are needed to identify risk factors and opportunities for improving primary and secondary stroke prevention.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».