Analysis Of Risk Factors For Hemorrhagic Transformation And Prognosis In Patients With Acute Ischemic Stroke After Intravenous Thrombolysis

Objective : To investigate risk factors of HT and prognosis after intravenous rt-PA thrombolysis in patients with AIS.Methods : A retrospective study was conducted on 156 patients who is treated with intravenous thrombolysis within 4.5 hours of symptom onset and complete data with acute ischemic stroke admitted to the first affliated hospital of Xinjiang Medical University from January 2017 to January 2019.The patients were divided into two groups : hemorrhagic transformation group(n=20)and control group(n=136).According to the clinical and laboratory data before thrombolysis,the risk factors that may be related to HT were screened out and the independent risk factors affecting HT were further analyzed by binary logistic regression analysis.According to the3 months and 12 months mRS scores of 0-3 and> 3,the patients were divided into the group with good prognosis and the group with poor prognosis.The possible risk factors were analyzed by single factor analysis according to their clinical data,and the independent influencing factors were further analyzed by multi-factor regression analysis.Results : Among 156 patients with thrombolysis,20(12.8%)had HT[among which6(3.8%)had symptomatic intracranial hemorrhage],18(11.5%)died at discharge;43(27.6%)had poor prognosis at 3 months,and 52(33.3%)had poor prognosis at12 months.Univariate analysis showed that age,history of atrial fibrillation,systolic and diastolic blood pressure at baseline before IVT,NIHSS score before IVT,NIHSS score 24 hours after IVT and baseline glucose were all associated with HT after IVT.Binary logistic analysis showed that history of atrial fibrillation(OR=81.4,95% CI 11.79-562.21,P<0.001),diastolic pressure at baseline before IVT(OR=1.07,95% CI 1.01-1.14,P=0.018),admission NIHSS score(OR=1.19,95% CI 1.03-1.39,P=0.022),and baseline blood glucose(OR=1.64,95% CI 1.07-2.50,P=0.022)were independent risk factors for HT.Single factor analysis showed that hypertension,diabetes,atrial fibrillation,APTT,baseline glucose,neutrophic to lymphotic ratio,platelet to lumphocyte ratio is associated with prognosis in 3 months after IVT.Logistic regression analysis indicates that atrial fibrillation(OR=10.26,95% CI 2.88-35.62,P<0.001)were independent risk predictor of prognosis in 3 months after IVT.Single factor analysis showed that hypertension,diabetes,atrial fibrillation,systolic blood pressure,diastolic blood pressure,and baseline blood glucose were associated with prognosis at 12 months after IVT.Logistic regression analysis showed that atrial fibrillation(OR=15.40,95% CI4.43-53.47,P<0.001)and systolic blood pressure(OR=1.03,95% CI 1.01-1.05,P=0.002)were independent risk factors for prognosis at 12 months.Conclusion : Atrial fibrillation,diastolic blood pressure at baseline before IVT,NIHSS score at admission,and blood glucose at baseline were independent risk factors for HT.AF were independent risk factors for poor prognosis at 3 months.AF,baseline systolic blood pressure were independent risk factors for poor prognosis at 12 months.