Data from: WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis

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.