INFOMATAS multi-center systematic review and meta-analysis individual patient data of dynamic cerebral autoregulation in ischemic stroke
Journal
International Journal of Stroke
Journal Volume
15
Journal Issue
7
Pages
807-812
Date Issued
2020
Author(s)
Beishon L.
Minhas J.S.
Nogueira R.
Castro P.
Budgeon C.
Aries M.
Robinson T.G.
Panerai R.B.
Abstract
Rationale: Disturbances in dynamic cerebral autoregulation after ischemic stroke may have important implications for prognosis. Recent meta-analyses have been hampered by heterogeneity and small samples. Aim and/or hypothesis: The aim of study is to undertake an individual patient data meta-analysis (IPD-MA) of dynamic cerebral autoregulation changes post-ischemic stroke and to determine a predictive model for outcome in ischemic stroke using information combined from dynamic cerebral autoregulation, clinical history, and neuroimaging. Sample size estimates: To detect a change of 2% between categories in modified Rankin scale requires a sample size of ?1500 patients with moderate to severe stroke, and a change of 1 in autoregulation index requires a sample size of 45 healthy individuals (powered at 80%, α = 0.05). Pooled estimates of mean and standard deviation derived from this study will be used to inform sample size calculations for adequately powered future dynamic cerebral autoregulation studies in ischemic stroke. Methods and design: This is an IPD-MA as part of an international, multi-center collaboration (INFOMATAS) with three phases. Firstly, univariate analyses will be constructed for primary (modified Rankin scale) and secondary outcomes, with key co-variates and dynamic cerebral autoregulation parameters. Participants clustering from within studies will be accounted for with random effects. Secondly, dynamic cerebral autoregulation variables will be validated for diagnostic and prognostic accuracy in ischemic stroke using summary receiver operating characteristic curve analysis. Finally, the prognostic accuracy will be determined for four different models combining clinical history, neuroimaging, and dynamic cerebral autoregulation parameters. Study outcome(s): The outcomes for this study are to determine the relationship between clinical outcome, dynamic cerebral autoregulation changes, and baseline patient demographics, to determine the diagnostic and prognostic accuracy of dynamic cerebral autoregulation parameters, and to develop a prognostic model using dynamic cerebral autoregulation in ischemic stroke. Discussion: This is the first international collaboration to use IPD-MA to determine prognostic models of dynamic cerebral autoregulation for patients with ischemic stroke. ? 2020 World Stroke Organization.
Subjects
adult
Article
autoregulation
Barthel index
brain blood flow
brain infarction size
brain ischemia
clinical outcome
computer assisted tomography
controlled study
diagnostic accuracy
diagnostic test accuracy study
disease severity
end tidal carbon dioxide tension
Glasgow coma scale
heart rate
human
image analysis
length of stay
major clinical study
mean arterial pressure
mortality rate
neuroimaging
nuclear magnetic resonance imaging
predictive value
priority journal
prognosis
Rankin scale
receiver operating characteristic
sensitivity and specificity
cerebrovascular accident
complication
diagnostic imaging
homeostasis
meta analysis
Brain Ischemia
Homeostasis
Humans
Ischemic Stroke
Neuroimaging
Stroke
Type
journal article