{
    "abstract": "Life-threatening, space-occupying mass effect due to cerebral edema and/or hemorrhagic transformation is an early complication of patients with middle cerebral artery stroke. Little is known about longitudinal trajectories of laboratory and vital signs leading up to radiographic and clinical deterioration related to this mass effect.\nWe curated a retrospective data set of 635 patients with large middle cerebral artery stroke totaling 95,463 data points for 10 longitudinal covariates and 40 time-independent covariates. We assessed trajectories of the 10 longitudinal variables during the 72\u00a0h preceding three outcomes representative of life-threatening mass effect: midline shift \u2265\u20095\u00a0mm, pineal gland shift (PGS) >\u20094\u00a0mm, and decompressive hemicraniectomy (DHC). We used a \"backward-looking\" trajectory approach. Patients were aligned based on outcome occurrence time and the trajectory of each variable was assessed before that outcome by accounting for cases and noncases, adjusting for confounders. We evaluated longitudinal trajectories with Cox proportional time-dependent regression.\nOf 635 patients, 49.0% were female, and the mean age was 69\u00a0years. Thirty five percent of patients had midline shift \u2265\u20095\u00a0mm, 24.3% of patients had PGS >\u20094\u00a0mm, and 10.7% of patients underwent DHC. Backward-looking trajectories showed mild increases in white blood cell count (10-11\u00a0K/UL within 72\u00a0h), temperature (up to half a degree within 24\u00a0h), and sodium levels (1-3\u00a0mEq/L within 24\u00a0h) before the three outcomes of interest. We also observed a decrease in heart rate (75-65 beats per minute) 24\u00a0h before DHC. We found a significant association between increased white blood cell count with PGS\u2009>\u20094\u00a0mm (hazard ratio 1.05, p value 0.007).\nLongitudinal profiling adjusted for confounders demonstrated that white blood cell count, temperature, and sodium levels appear to increase before radiographic and clinical indicators of space-occupying mass effect. These findings will inform the development of multivariable dynamic risk models to aid prediction of life-threatening, space-occupying mass effect.",
    "authors": [
        {
            "affiliation": "Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA. Cjong@bu.edu.\nChobanian and Avedisian School of Medicine, Boston University School of Medicine, 85 E Concord St, Boston, MA, 02118, USA. Cjong@bu.edu.\nDepartment of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. Cjong@bu.edu.",
            "firstname": "Charlene J",
            "initials": "CJ",
            "lastname": "Ong"
        },
        {
            "affiliation": "Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.",
            "firstname": "Qiuxi",
            "initials": "Q",
            "lastname": "Huang"
        },
        {
            "affiliation": "Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.",
            "firstname": "Ivy So Yeon",
            "initials": "ISY",
            "lastname": "Kim"
        },
        {
            "affiliation": "Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.",
            "firstname": "Jack",
            "initials": "J",
            "lastname": "Pohlmann"
        },
        {
            "affiliation": "Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.",
            "firstname": "Stefanos",
            "initials": "S",
            "lastname": "Chatzidakis"
        },
        {
            "affiliation": "New York University Langone Hospital and NYU Grossman School of Medicine, 550 1St Ave, New York, NY, 10016, USA.",
            "firstname": "Benjamin",
            "initials": "B",
            "lastname": "Brush"
        },
        {
            "affiliation": "Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.",
            "firstname": "Yihan",
            "initials": "Y",
            "lastname": "Zhang"
        },
        {
            "affiliation": "Chobanian and Avedisian School of Medicine, Boston University School of Medicine, 85 E Concord St, Boston, MA, 02118, USA.",
            "firstname": "Yili",
            "initials": "Y",
            "lastname": "Du"
        },
        {
            "affiliation": "Chobanian and Avedisian School of Medicine, Boston University School of Medicine, 85 E Concord St, Boston, MA, 02118, USA.",
            "firstname": "Leigh Ann",
            "initials": "LA",
            "lastname": "Malinger"
        },
        {
            "affiliation": "Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.\nDepartment of Cardiology, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, 85 E Concord St, Boston, MA, 02118, USA.",
            "firstname": "Emelia J",
            "initials": "EJ",
            "lastname": "Benjamin"
        },
        {
            "affiliation": "Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.\nDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College, Montreal, QC, Canada.",
            "firstname": "Jos\u00e9e",
            "initials": "J",
            "lastname": "Dupuis"
        },
        {
            "affiliation": "Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.\nChobanian and Avedisian School of Medicine, Boston University School of Medicine, 85 E Concord St, Boston, MA, 02118, USA.",
            "firstname": "David M",
            "initials": "DM",
            "lastname": "Greer"
        },
        {
            "affiliation": "Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.\nDepartment of Neurology, Jamaica Plain Veterans Administration Medical Center, 150 S Huntington Ave, Boston, MA, 02130, USA.",
            "firstname": "Stelios M",
            "initials": "SM",
            "lastname": "Smirnakis"
        },
        {
            "affiliation": "Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.\nTufts Clinical and Translational Science Institute, Tufts University, 419 Boston Ave, Medford, MA, 02155, USA.",
            "firstname": "Ludovic",
            "initials": "L",
            "lastname": "Trinquart"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.",
    "doi": "10.1007/s12028-024-02036-9\n10.1016/j.jns.2019.116607\n10.1136/jnis-2022-019404\n10.1161/01.str.32.2.442\n10.1001/jamaneurol.2017.5162\n10.1212/wnl.49.4.1090\n10.1002/sim.8085\n10.1161/01.str.30.8.1534\n10.1161/STR.0b013e318284056a.\n10.1161/STR.0000000000000211\n10.1056/NEJMoa1706442\n10.1056/NEJMoa1713973.\n10.1227/NEU.0000000000001432\n10.3389/fneur.2022.1046548\n10.1007/s12028-019-00844-y\n10.1159/000113736\n10.21037/atm.2018.02.12\n10.1016/0090-3019(88)90140-1",
    "journal": "Neurocritical care",
    "keywords": [
        "Cerebral edema",
        "Ischemic stroke",
        "Midline shift",
        "Trajectory analysis"
    ],
    "methods": null,
    "publication_date": "2024-07-03",
    "pubmed_id": "38955931\n30571414\n31830611\n28487333\n24423583\n36207112\n11157180\n29365017\n34494212\n9339695\n30614014\n10436096\n23370205\n31662037\n26396032\n29129157\n29364767\n19269254\n17690310\n24645942\n17690311\n3960059\n27654000\n36561299\n31549349\n18212524\n31390924\n29955581\n3375974",
    "results": "Of 635 patients, 49.0% were female, and the mean age was 69\u00a0years. Thirty five percent of patients had midline shift \u2265\u20095\u00a0mm, 24.3% of patients had PGS >\u20094\u00a0mm, and 10.7% of patients underwent DHC. Backward-looking trajectories showed mild increases in white blood cell count (10-11\u00a0K/UL within 72\u00a0h), temperature (up to half a degree within 24\u00a0h), and sodium levels (1-3\u00a0mEq/L within 24\u00a0h) before the three outcomes of interest. We also observed a decrease in heart rate (75-65 beats per minute) 24\u00a0h before DHC. We found a significant association between increased white blood cell count with PGS\u2009>\u20094\u00a0mm (hazard ratio 1.05, p value 0.007).",
    "title": "Association of Dynamic Trajectories of Time-Series Data and Life-Threatening Mass Effect in Large Middle Cerebral Artery Stroke.",
    "xml": "<Element 'PubmedArticle' at 0x788503d37b00>"
}