Predictors of malignant cerebral edema in cerebral artery infarction: A meta-analysis

Malignant cerebral edema (MCE) is a life-threatening complication of acute cerebral stroke. To date, the focus has been on symptomatic treatment, rather than on prevention. Therefore, to identify high-risk patients and explore potential therapeutic approaches, we investigated the possible predictors of MCE. Specifically, we performed a meta-analysis to identify the potential predictors of MCE in patients with acute cerebral infarction. We searched the MEDLINE, Embase, Cochrane, China National Knowledge Infrastructure, Wanfang Data, and VIP databases from their inception to July 2018 for cohort and case control studies on the predictors of MCE in patients with cerebral infarction. Forty-seven eligible studies containing a total of 45,826 patients were included. Our results suggest that the risk of MCE is higher in case of severe clinical symptoms and large infarct volumes. Additionally, male sex, older age, and a history of stroke and smoking were protective factors against MCE in cerebral infarction patients. Furthermore, thrombolytic therapy and recanalization substantially decreased the risk of MCE in patients with acute stroke. Higher admission temperature (in the subgroup with admission ≤12 h after onset), higher admission blood pressure, and admission leukocytes were also MCE predictors. Our findings facilitate the early prediction of MCE and may contribute to potential therapeutic approaches.