Data from: WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis
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Feb 19, 2019 version files
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Abstract
OBJECTIVE: To investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality. METHODS: Following the MOOSE and PRISMA guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later post-stroke. We extracted data and evaluated study quality with the Newcastle-Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models. RESULTS: We included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR: 2.17, 95%CI: 1.72-2.73), cognitive impairment (RR: 2.29, 95%CI: 1.48-3.54), functional impairment (RR: 2.21, 95%CI: 1.83-2.67), any recurrent stroke (RR: 1.65, 95%CI: 1.36-2.01), recurrent ischemic stroke (RR: 1.90, 95%CI: 1.26-2.88), all-cause mortality (RR: 1.72, 95%CI: 1.47-2.01), and cardiovascular mortality (RR: 2.02, 95%CI: 1.44-2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias. CONCLUSIONS: Presence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.
Online Supplement
Online Supplementary data for the following article:
Georgakis MK, Duering M, Wardlaw JM, Dichgans M. WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis.
CONTENTS:
e-Methods.
Table e-1. Excluded articles and reasons for exclusion.
Table e-2. Articles excluded due to overlapping populations with other eligible studies.
Table e-3. Characteristics of eligible articles by examined outcomes.
Table e-4. Quality score of eligible articles by examined outcomes, as assessed by the Newcastle Ottawa scale.
Table e-5. Sensitivity analyses restricted to studies fulfilling each of the Newcastle-Ottawa scale quality prerequisites per scale item.
Table e-6. Meta-regression analyses for the effect of different study characteristics on the association of white matter hyperintensities at baseline (moderate/severe vs. mild/none) with stroke outcomes.
Table e-7. Assessment of publication bias with the Egger’s test in the analysis of the associations of white matter hyperintensities (WMH) with stroke outcomes.
Figure e-1. Forest plots depicting the associations of white matter hyperintensities (WMH) with (A) dementia and (B) cognitive impairment.
Figure e-2. Forest plots depicting the associations of white matter hyperintensities (WMH) with (A) any functional impairment, (B) functional impairment defined as mRS >1, and (C) functional impairment defined as mRS >2.
Figure e-3. Forest plots depicting the associations of white matter hyperintensities (WMH) with (A) any recurrent stroke, and (B) recurrent ischemic stroke.
Figure e-4. Forest plots depicting the associations of white matter hyperintensities (WMH) with (A) all-cause mortality, and (B) cardiovascular mortality.
Figure e-5. Forest plots depicting the associations of white matter hyperintensities (WMH) volume with any functional impairment.
Figure e-6. Forest plots depicting the summary association estimates between white matter hyperintensities (WMH) and study outcomes, when excluding studies based on secondary analyses of randomized controlled trials.
Figure e-7. Forest plots depicting the summary association estimates between white matter hyperintensities (WMH) and study outcomes derived from sensitivity analyses restricted to studies that have analyzed their data with Cox regression models and have provided Hazard Ratios as estimates of association.
Figure e-8. Dose-response meta-analysis of the association of white matter hyperintensities burden at baseline with stroke outcomes in studies adjusting for age, stroke severity and cardiovascular risk factors. The graphs depict the restricted cubic spline derived effect estimates and their 95% confidence intervals for (A) dementia, (B) any functional impairment, (C) any recurrent stroke, and (D) all-cause mortality.
Figure e-9. Funnel plots for the associations of white matter hyperintensities (WMH) with (A) dementia, (B) any functional impairment, (D) any recurrent stroke, and (D) all-cause mortality.
e-References.
wmh_supplement_R1.pdf
