DOI: 10.5061/dryad.8b62gn1
title: Data from: WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis

description: OBJECTIVE: To investigate the relationship between baseline white matter
 hyperintensities (WMH) in patients with ischemic stroke and long-term risk
 of dementia, functional impairment, recurrent stroke, and mortality.
 METHODS: Following the MOOSE and PRISMA guidelines (PROSPERO protocol:
 CRD42018092857), we systematically searched Medline and Scopus for cohort
 studies of ischemic stroke patients examining whether MRI- or CT-assessed
 WMH at baseline are associated with dementia, functional impairment,
 recurrent stroke, and mortality at 3 months or later post-stroke. We
 extracted data and evaluated study quality with the Newcastle-Ottawa
 scale. We pooled relative risks (RR) for the presence and severity of WMH
 using random-effects models. RESULTS: We included 104 studies with 71,298
 ischemic stroke patients. Moderate/severe WMH at baseline were associated
 with increased risk of dementia (RR: 2.17, 95%CI: 1.72-2.73), cognitive
 impairment (RR: 2.29, 95%CI: 1.48-3.54), functional impairment (RR: 2.21,
 95%CI: 1.83-2.67), any recurrent stroke (RR: 1.65, 95%CI: 1.36-2.01),
 recurrent ischemic stroke (RR: 1.90, 95%CI: 1.26-2.88), all-cause
 mortality (RR: 1.72, 95%CI: 1.47-2.01), and cardiovascular mortality (RR:
 2.02, 95%CI: 1.44-2.83). The associations followed dose-response patterns
 for WMH severity and were consistent for both MRI- and CT-defined WMH. The
 results remained stable in sensitivity analyses adjusting for age, stroke
 severity, and cardiovascular risk factors, in analyses of studies scoring
 high in quality, and in analyses adjusted for publication bias.
 CONCLUSIONS: Presence and severity of WMH are associated with
 substantially increased risk of dementia, functional impairment, stroke
 recurrence, and mortality after ischemic stroke. WMH may aid clinical
 prognostication and the planning of future clinical trials.
description: Online
 SupplementOnline Supplementary
 data for the following article: Georgakis MK, Duering M, Wardlaw JM,
 Dichgans M. WMH and long-term outcomes in ischemic stroke: a systematic
 review and meta-analysis. CONTENTS: e-Methods. Table e-1. Excluded
 articles and reasons for exclusion. Table e-2. Articles excluded due to
 overlapping populations with other eligible studies. Table e-3.
 Characteristics of eligible articles by examined outcomes. Table e-4.
 Quality score of eligible articles by examined outcomes, as assessed by
 the Newcastle Ottawa scale. Table e-5. Sensitivity analyses restricted to
 studies fulfilling each of the Newcastle-Ottawa scale quality
 prerequisites per scale item. Table e-6. Meta-regression analyses for the
 effect of different study characteristics on the association of white
 matter hyperintensities at baseline (moderate/severe vs. mild/none) with
 stroke outcomes. Table e-7. Assessment of publication bias with the
 Egger’s test in the analysis of the associations of white matter
 hyperintensities (WMH) with stroke outcomes. Figure e-1. Forest plots
 depicting the associations of white matter hyperintensities (WMH) with (A)
 dementia and (B) cognitive impairment. Figure e-2. Forest plots depicting
 the associations of white matter hyperintensities (WMH) with (A) any
 functional impairment, (B) functional impairment defined as mRS &gt;1, and
 (C) functional impairment defined as mRS &gt;2. Figure e-3. Forest plots
 depicting the associations of white matter hyperintensities (WMH) with (A)
 any recurrent stroke, and (B) recurrent ischemic stroke. Figure e-4.
 Forest plots depicting the associations of white matter hyperintensities
 (WMH) with (A) all-cause mortality, and (B) cardiovascular mortality.
 Figure e-5. Forest plots depicting the associations of white matter
 hyperintensities (WMH) volume with any functional impairment. Figure e-6.
 Forest plots depicting the summary association estimates between white
 matter hyperintensities (WMH) and study outcomes, when excluding studies
 based on secondary analyses of randomized controlled trials. Figure e-7.
 Forest plots depicting the summary association estimates between white
 matter hyperintensities (WMH) and study outcomes derived from sensitivity
 analyses restricted to studies that have analyzed their data with Cox
 regression models and have provided Hazard Ratios as estimates of
 association. Figure e-8. Dose-response meta-analysis of the association of
 white matter hyperintensities burden at baseline with stroke outcomes in
 studies adjusting for age, stroke severity and cardiovascular risk
 factors. The graphs depict the restricted cubic spline derived effect
 estimates and their 95% confidence intervals for (A) dementia, (B) any
 functional impairment, (C) any recurrent stroke, and (D) all-cause
 mortality. Figure e-9. Funnel plots for the associations of white matter
 hyperintensities (WMH) with (A) dementia, (B) any functional impairment,
 (D) any recurrent stroke, and (D) all-cause mortality.
 e-References. wmh_supplement_R1.pdf