Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis
Abstract Background and purpose Silent cerebral infarcts (SCIs) are the most common neurological complication in children and adults with sickle cell disease (SCD). In this systematic review, we provide an overview of studies that have detected SCIs in patients with SCD by cerebral magnetic resonanc...
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | BMC Medicine |
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| Online Access: | https://doi.org/10.1186/s12916-020-01864-8 |
| _version_ | 1818565176032493568 |
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| author | Maite E. Houwing Rowena L. Grohssteiner Marjolein H. G. Dremmen Ferdows Atiq Wichor M. Bramer Anne P. J. de Pagter C. Michel Zwaan Tonya J. H. White Meike W. Vernooij Marjon H. Cnossen |
| author_facet | Maite E. Houwing Rowena L. Grohssteiner Marjolein H. G. Dremmen Ferdows Atiq Wichor M. Bramer Anne P. J. de Pagter C. Michel Zwaan Tonya J. H. White Meike W. Vernooij Marjon H. Cnossen |
| author_sort | Maite E. Houwing |
| collection | DOAJ |
| description | Abstract Background and purpose Silent cerebral infarcts (SCIs) are the most common neurological complication in children and adults with sickle cell disease (SCD). In this systematic review, we provide an overview of studies that have detected SCIs in patients with SCD by cerebral magnetic resonance imaging (MRI). We focus on the frequency of SCIs, the risk factors involved in their development and their clinical consequences. Methods The databases of Embase, MEDLINE ALL via Ovid, Web of Science Core Collection, Cochrane Central Register of Trials via Wiley and Google Scholar were searched from inception to June 1, 2019. Results The search yielded 651 results of which 69 studies met the eligibility criteria. The prevalence of SCIs in patients with SCD ranges from 5.6 to 80.6% with most studies reported in the 20 to 50% range. The pooled prevalence of SCIs in HbSS and HbSβ0 SCD patients is 29.5%. SCIs occur more often in patients with the HbSS and HbSβ0 genotype in comparison with other SCD genotypes, as SCIs are found in 9.2% of HbSC and HbSβ+ patients. Control subjects showed a mean pooled prevalence of SCIs of 9.8%. Data from included studies showed a statistically significant association between increasing mean age of the study population and mean SCI prevalence. Thirty-three studies examined the risk factors for SCIs. The majority of the risk factors show no clear association with prevalence, since more or less equal numbers of studies give evidence for and against the causal association. Conclusions This systematic review and meta-analysis shows SCIs are common in patients with SCD. No clear risk factors for their development were identified. Larger, prospective and controlled clinical, neuropsychological and neuroimaging studies are needed to understand how SCD and SCIs affect cognition. |
| first_indexed | 2024-12-14T01:37:52Z |
| format | Article |
| id | doaj.art-bf5dbc08a2204ce6967ebba2efb69a74 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-14T01:37:52Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-bf5dbc08a2204ce6967ebba2efb69a742022-12-21T23:21:50ZengBMCBMC Medicine1741-70152020-12-0118111710.1186/s12916-020-01864-8Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysisMaite E. Houwing0Rowena L. Grohssteiner1Marjolein H. G. Dremmen2Ferdows Atiq3Wichor M. Bramer4Anne P. J. de Pagter5C. Michel Zwaan6Tonya J. H. White7Meike W. Vernooij8Marjon H. Cnossen9Department of Pediatric Haematology and Oncology, Erasmus MC – Sophia Children’s HospitalDepartment of Pediatric Haematology and Oncology, Erasmus MC – Sophia Children’s HospitalDepartment of Pediatric Radiology, Erasmus MC – Sophia Children’s HospitalDepartment of Haematology, Erasmus MCMedical Library, Erasmus MCDepartment of Pediatric Haematology and Oncology, Erasmus MC – Sophia Children’s HospitalDepartment of Pediatric Haematology and Oncology, Erasmus MC – Sophia Children’s HospitalDepartment of Child and Adolescent Psychiatry, Erasmus MC – Sophia Children’s HospitalDepartment of Radiology and Nuclear Medicine, Erasmus MCDepartment of Pediatric Haematology and Oncology, Erasmus MC – Sophia Children’s HospitalAbstract Background and purpose Silent cerebral infarcts (SCIs) are the most common neurological complication in children and adults with sickle cell disease (SCD). In this systematic review, we provide an overview of studies that have detected SCIs in patients with SCD by cerebral magnetic resonance imaging (MRI). We focus on the frequency of SCIs, the risk factors involved in their development and their clinical consequences. Methods The databases of Embase, MEDLINE ALL via Ovid, Web of Science Core Collection, Cochrane Central Register of Trials via Wiley and Google Scholar were searched from inception to June 1, 2019. Results The search yielded 651 results of which 69 studies met the eligibility criteria. The prevalence of SCIs in patients with SCD ranges from 5.6 to 80.6% with most studies reported in the 20 to 50% range. The pooled prevalence of SCIs in HbSS and HbSβ0 SCD patients is 29.5%. SCIs occur more often in patients with the HbSS and HbSβ0 genotype in comparison with other SCD genotypes, as SCIs are found in 9.2% of HbSC and HbSβ+ patients. Control subjects showed a mean pooled prevalence of SCIs of 9.8%. Data from included studies showed a statistically significant association between increasing mean age of the study population and mean SCI prevalence. Thirty-three studies examined the risk factors for SCIs. The majority of the risk factors show no clear association with prevalence, since more or less equal numbers of studies give evidence for and against the causal association. Conclusions This systematic review and meta-analysis shows SCIs are common in patients with SCD. No clear risk factors for their development were identified. Larger, prospective and controlled clinical, neuropsychological and neuroimaging studies are needed to understand how SCD and SCIs affect cognition.https://doi.org/10.1186/s12916-020-01864-8Sickle cell diseaseSilent cerebral infarctionStrokeMagnetic resonance imaging |
| spellingShingle | Maite E. Houwing Rowena L. Grohssteiner Marjolein H. G. Dremmen Ferdows Atiq Wichor M. Bramer Anne P. J. de Pagter C. Michel Zwaan Tonya J. H. White Meike W. Vernooij Marjon H. Cnossen Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis BMC Medicine Sickle cell disease Silent cerebral infarction Stroke Magnetic resonance imaging |
| title | Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis |
| title_full | Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis |
| title_fullStr | Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis |
| title_full_unstemmed | Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis |
| title_short | Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis |
| title_sort | silent cerebral infarcts in patients with sickle cell disease a systematic review and meta analysis |
| topic | Sickle cell disease Silent cerebral infarction Stroke Magnetic resonance imaging |
| url | https://doi.org/10.1186/s12916-020-01864-8 |
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