The Progrosis And Risk Factors Of Asymptomatic Hemorrhagic Transformation After Acute Ischemic Stroke

Backgroud and Objectives: Brain vascular disease is the one of the most serious disease,which results in high rate disability.Asymptomatic,and 80 percent of which is acute ischemic sroke.Many complication after stroke could aggravate symptoms,while hemorrhagic transformation is the most common one.The definition of HT is that blood cells spill out from brain vessels after acute ischemic stroke.HT can be detected using routine computed tomography(CT)scanning or magnetic resonance imaging(MRI).HT could be sorted to asymptomatic hemorrhagic transformation and symptomatic hemorrhagic transformation.Symptomatic hemorrhagic transformation aggravate symptoms with NIHSS Score increase more than 4 scores through CT,while asymptomatic hemorrhagic transformation not.Several risk factors for HT have been identified in patients with cerebral infarction,including vascular risk factors,changes in brain imaging,infarct area,revascularization time,stroke severity,blood pressure,changes in blood glucose,platelet counts,and use of anti-platelet,anticoagulant or thrombolytic therapies.The best treatment for acute ischemic stroke is early cerebral artery recanalization with intravenous recombinanttissue plasminogen activator(rt-PA).However,rt-PA induced hemorrhagic transformation(HT)may cause rapid and severe neurologic deterioration.Asymptomatic hemorrhagic transformation is not associated with immediate deterioration of patients with acute ischemic stroke.However,it is unclear whether it is clinically innocuous with respect to long-term outcome.Thus in order to improve the outcome and decline occurrence of HT,it is nessecary for us to research the risk factors and progonosis of HT.The aim of this study was to determine the impact of asymptomatic HT on 3-month outcome and relative risk factors.Methods: All 448 patients hospitalized between August 2015 and August 2016 for ischemic stroke within 14 days from symptom onset,The clinic records and laboratory datas of pre-and post-treatment were statistically analyzed between HT group and non-HT group to find potential risk factors to HT,while,in order to find discrepancy of longtime outcome between HT group and non-HT group,90-days mRS scores were statistically analyzed through telephone contact.Results: HT occurred in 44 patients(9.82%),including 2 patients died(4.50% of HT),and the total casualty is 9.The crude ORs of asymptomatic HT for an increment of mRS score at 3months were 5.86.Univariate analysis showed that high blood pressure、high blood lipid 、atrial fibrillation、 Large brain infarction、High NIHSS score were associated with asHT(P<0.05).Post-cerebral infarction(p=0.002)is protective factors for asHT.While diabetes、smoking、different gender、age、history of stroke and tumor had no relationship with asHT(P>0.05).Logistic regression analysis showed that history of atrial fibrillation(OR = 2.096,95% CI 1.923-4.757,P =0.047),Large brain infarction(OR=10.455,P<0.001,95%CI 4.765-22.940),High NIHSS score(OR=1.123,P=0.015,95%CI 1.023-1.232)are independent risk factors for asHT.Conclusion: Our study shows that the odds of a worse outcome are increased by a factor of 5.86 in patients with asymptomatic HT compared with those without HT after acute ischemic stroke,and history of atrial fibrillation,Large brain infarction,High NIHSS score are independent risk factors for asHT.While post-cerebral infarction is protective factors for asHT.