Study On Impact Factors And Predictors For Hemorrhagic Transformation In Ischemic Stroke

Part â… Study on Impact Factors for SpontaneousHemorrhagic Transformation in Ischemic StrokeBackground: Identifying significant predictors of hemorrhagic transformation (HT) would be helpful not only in improvement of diagnosis , treatment and prognosis of patients with HT, but also in guiding selection of candidates for thrombolysis. Presently, most researches on HT are associated with thrombolytic treatment. The number of prospective studies on spontaneous HT is not many and their results are not very agreeable. Objectives: To characterize the frequency of spontaneous HT in patients with ischemic stroke ; to characterize impact factors of spontaneous HT in our cohort.Materials and methods: 1. Between 2002/03/01 and 2005/03/05, the consecutive cases of ischemic stroke, verified using CT and the WHO's clinical diagnostic criteria for stroke, were prospectively registered at the neurological wards of the West China Hospital, Sichuan University. All clinical characteristics during hospitalization related to HT were collected, and the HT and infarct area were analyzed from the 2nd CT/MRI performed after third day of symptom onset or when condition desterotation. 2. Firstly, HT were analyzed in relation to clinical characteristics by using univariate analysis. Secondly, multivariate logistical regression was utilized to detectthe independent impact factors of spontaneous HT.Results: 407 cases of ischemic stroke were included. HT was observed in 50 patients (12.3%): 33 (66%) had a hemorrhagic infarction, and 17 (34%) had a parenchymal hematoma; 32(64%) was non-symptomatic; 18 (36%) was symptomatic. Most HT (40%) were found by CT/MRI during days 4 through 7 of symptom onset. Coronary heart disease, arterial fibrillation, cardioembolic stroke, infact area, time from stroke onset to admission, Glasgow Coma Scale(GCS) at admission, The National Institutes of Health Stroke Scale(NIHSS) at admission were significantly associated with subsequent HT of ischemic stroke in the univariate analysis. Multivariate analysis demonstrated that arterial fibrillation (OR 4.7; 95% CI 1.16-19.34; P <0.05)and infarct area (OR 4.15; 95% CI 1.72-10.03; P <0.01) were independent predictors of hemorrhagic transformation (HT) in ischemic stroke.Conclusion: 1. 50 (12.3%) of 407 patients included in the study showed HT, and non-symptomatic HT were more than 50%. Most parenchymal hemorrhage were symptomatic, and most hemorrhagic infartion were non-symtomatic as well. 2. Repeated radiological should be suggested for patients with risk factors of HT, and it may be better during days 4 through 7 of symptom onset. 3. Arterial fibrillation and large infarct area were independent predictors of spontaneous hemorrhagic transformation (HT) in ischemic stroke. The number of known affecting factors that could accurately and timely predicting HT is limited, and potential mechanism of HT should be explored, and newer predictors are required.