Risk Factors For Subtypes Of Hemorrhagic Transformation After Cerebral Infarction

ObjectiveTo investigate the risk factors of hemorrhagic transformation(HT)of cerebral infarction and the differences of risk factors among HT subtypes,and analyse the association of hemorrhagic transformation and ischemic stroke subtypes as defined by Chinese Ischemic Stroke Subclassification(CISS).MethodsThe demographic,history,clinical and imaging data of 155 consecutive cases of acute ischemic stroke with HT in the First Affiliated Hospital of Anhui University from September 2014 to September 2016 were prospectively documented.Among the four subtypes of HT according to ECASS include haemorrhagic infarction-1(HI-1),HI-2 and parenchymal haemorrhage-1(PH-1),PH-2.250 cases of acute ischemic stroke without HT were designated as the control group by methods of simple random sampling from the hospitalized patients in the same period.Factors which may influence the occurrence of HT were compared and analyzed between the two groups,and the independent risk factors of HT subtypes were further analyzed by logistic regression.Results1.HT was commonly seen in two weeks after cerebral infarction.Among the four subtypes of HT according to ECASS,hemorrhagic infarction-1(HI-1)is most frequent(43.87%),then hemorrhagic infarction-2(HI-2)(33.55%),with parenchymal haemorrhage-1(PH-1)(12.26%)and parenchymal haemorrhage-2(PH-2)(10.32%)being less common.2.The ischemic stroke with hemorrhagic transformation are commonly seen in subtypes of large artery atherosclerosis and cardioembolism in CISS.3.Sixteen risk factors including massive cerebral infarction,involvement of cerebral cortex,scores of the National Institutes of Health Stroke Scale(NIHSS)on admission,antithrombotic therapy,etiological categories according to CISS were statistically significant between HT and non-HT group(P<0.05).Multivariate logistic regression analysis demonstrated that massive cerebral infarction(OR:2.912,95%CI:1.521~5.575),involvement of cerebral cortex(OR:2.664,95%CI:1.385~5.122),the NIHSS score on admission(OR:1.066,95%CI:1.015~1.120)and age(OR:1.029,95%CI:1.005~1.054)were the independent risk factors for HT after cerebral infarction.Patients with ischemic stroke caused by penetrating artery disease in CISS and high low density lipoprotein cholesterol were less likely to have HT.4.There exist some differences in risk factors for various subtypes of HT,involvement of cerebral cortex being the independent risk factors of HI-1 and PH-1,massive cerebral infarction being the independent risk factor of HI-2 and PH-2,the NIHSS scores on admission being the independent risk factor of HI-2,PH-1 and PH-2,history of diabetes being the independent risk factors of HI-1.Patients with ischemic stroke caused by penetrating artery disease in CISS were less likely to have HI-1.Conclusion1.HT was commonly seen in two weeks after onset of cerebral infarction.HI-1 is most frequent among the four subtypes of HT according to ECASS.2.Massive cerebral infarction,involvement of cerebral cortex,the score of NIHSS on admission and age were the independent risk factors of HT after cerebral infarction.3.The most common subtypes of ischemic stroke in CISS developing hemorrhagic transformation are large artery atherosclerosis and cardioembolism.4.There exist differences of risk factors among subtypes of hemorrhagic transformation.Involvement of cerebral cortex,history of diabetes were the independent risk factors of HI-1,and patients with ischemic stroke caused by penetrating artery disease in CISS were less likely to have HI-1.Massive cerebral infarction,and the score of on admission were the independent risk factors of HI-2.Involvement of cerebral cortex,and the score of on admission were the independent risk factors of PH-1 after cerebral infarction,Massive cerebral infarction,and the score of on admission also were the independent risk factors of PH-2.