Meta-analysis Of The Association Between Traumatic Brain Injury And Stroke

Objective:We used meta-analysis to investigate the correlation between traumatic brain injury(TBI)and stroke(including both hemorrhagic and ischemic stroke),and to explore,the pathogenesis,risk factors and prognostic characteristics of posttraumatic cerebral infarction(PTCI).Methods:Part I: Cohort studies involving patients with TBI with subsequent stroke were searched in three databases,Pub Med,EMBASE and Cochrane.The search deadline was December 31,2020.Screening of the literature,data extraction and quality evaluation were performed by two independent researchers.Statistical analysis was performed using Stata12.0,and the relationship between TBI and stroke was analyzed using Meta-analysis.A random-effects model was applied for data analysis,and subgroup analysis was performed by stroke type.Part II: Studies were searched and screened in three databases,Pub Med,EMBASE and Cochrane,according to the inclusion and exclusion criteria that were set.The search deadline was February 30,2022.Screening of the literature,data extraction and quality evaluation were performed by two independent researchers.Statistical analysis was performed using Stata12.0,and Meta-analysis was used to analyze the pathogenesis,risk factors and prognostic characteristics of PTCI.Fixed-effects models were applied for data analysis.Results:Part I: Of the 741 identified studies,6 studies were eligible for inclusion,with more than2200000 participants.TBI predicted the occurrence of stroke in the random-effect model,with a relative risk of 2.14(95% CI 1.97-2.32,P<0.001).Furthermore,in the analysis of each type of stroke,TBI was associated with the incidence of ischemic stroke(RR 1.351 95% CI 1.212-1.506,P<0.001),and TBI was associated with an even greater increase in the incidence of hemorrhagic stroke(RR 6.118 95% CI 5.265-7.108,P<0.001).Part II: A total of 9 studies were included in our meta-analysis.The study findings suggested that the pooled incidence of PTCI in patients with moderate to severe TBI is 16%(95% CI 12-21);the incidence of PTCI in the first two week is significantly higher than that in the rest of the period(χ2=56.769,P<0.001);the incidence of PTCI in the blood supply area of PCA,MCA and ACA are higher than that in other areas(χ2=6.234,P=0.013).The occurrence of PTCI is associated with several risk factors,including low GCS score(RR=5.887,95% CI 3.191-10.861),low systolic blood pressure(RR=2.857,95% CI 1.991-4.099),brain herniation(RR=1.813,95% CI 1.314-2.502),elevated ICP(RR=4.667,95% CI2.183-9.975),hyperthermia(RR=2.417,95% CI 1.567-3.726),thrombocytopenia(RR=3.988,95% CI 2.753-5.776),thrombocytopenia(RR=3.988,95% CI 2.753-5.776),prothrombin time(RR=1.825,95% CI 1.246-2.673)and decompressive craniectomy(RR=1.813,95% CI 1.314-2.502).The occurrence of PTCI is strongly associated with poor outcomes 3–6 months later,and the mortality rate in patients with PTCI is approximately 39.4%(95% CI 33.8-45.0).Conclusion:(1)TBI is associated with stroke.And both hemorrhagic and ischemic stroke are associated with TBI.(2)PTCI is a common complication in patients with moderate-to-severe TBI and is influenced by risk factors such as GCS score,systolic blood pressure and intracranial pressure,and has a poor prognosis.