Table 1.
Clinical and biological risk factors for ischemic stroke in sickle cell disease.
| Study (year) | Risk factor | Odds ratio (95% CI) | p-value | Participants | Comments | Ref. |
|---|---|---|---|---|---|---|
| Houston et al. (1997) | Homocysteine (> median) | 3.5 (1.1–12) | 0.03 | 16 with stroke 83 without stroke | 50% adults, corrected for age, stroke type not specified | [66] |
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| Miller et al. (2001) | Silent cerebral infarct | 14 | 0.006 | 248 children | Infant cohort of the CSSCD | [67] |
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| Kirkham et al. (2001) | Nocturnal SaO2 (for every 1% increase) | Hazard ratio: 0.82 (0.7–0.9) | 0.003 | 19 with CNS events 76 without CNS events | 7 strokes, 8 TIAs, 4 seizures | [68] |
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| Adams et al. (1997) | Elevated MCA/dICA CBFV | Risk ratio: | 315 children | Patients from the Medical College of Georgia cohort | [69] | |
| 170–199 cm/s | 3.5 (0.7–17) | 0.16 | ||||
| ≥200 cm/s | 17 (6.9–40) | <0.0001 | ||||
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| Kwiatkowski et al. (2006) | Isolated elevated ACA CBFV (>170 cm/s) | 10.5 | <0.001 | 54 strokes in 1975 children | Analysis of screening TCDs from STOP | [70] |
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| Wierenga et al. (2001) | Aplastic crisis | 58 | 5 strokes in 346 aplastic crises | Children with HbSS in Kingston, Jamaica Sickle Clinic | [14] | |
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| Ohene-Frempong et al. (1998) | Prior TIA | 56 (12–285) | <0.001 | 2436 children and adults with HbSS | Did not report children and adults separately | [3] |
| Steady-state Hb (per g/dl) | 1.9 (1.3–2.6) | <0.001 | ||||
| ACS within 2 weeks | 7 (1.8–27) | 0.001 | ||||
| ACS rate (event/year) | 2.4 (1.3–4.5) | 0.005 | ||||
| SBP (10 mm increase) | 1.3 (1.03–1.7) | 0.033 | ||||
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| Strouse et al. (2009) | Hypertension | 4.1 (2.9–5.7) | <0.0001 | 255 acute strokes among 69,586 discharges with diagnosis of sickle cell disease | Did not report children and adults separately | [7] |
| Diabetes mellitus | 2.2 (1.2–3.9) | <0.05 | ||||
| Hyperlipidemia | 6.9 (2.9–14) | <0.0001 | ||||
| Renal disease | 4.2 (2.4–6.8) | <0.0001 | ||||
| Atrial fibrillation | 4.9 (2.2–9.5) | <0.0005 | ||||
ACA: Anterior cerebral artery; ACS: Acute chest syndrome; CBFV: Cerebral blood flow velocity; CSSCD: Cooperative Study of Sickle Cell Disease; dICA: Distal internal carotid artery; Hb: Hemoglobin; HbSS: Sickle cell anemia; MCA: Middle cerebral artery; SaO2: Oxygen saturation; SBP: Systolic blood pressure; STOP: Stroke Prevention Study; TCD: Transcranial Doppler ultrasound; TIA: Transient ischemic attack.