Analysis Of Related Risk Factors Of Hemorrhagic Transformation After Intravenous Thrombolysis In Acute Ischemic Stroke

Background and objective: Hemorrhagic transformation(HT)is a common complication of ischemic stroke.HT is associated with poor clinical prognosis in patients with ischemic stroke.The purpose of this study was to investigate the risk factors of hemorrhagic transformation(HT)and symptomatic hemorrhagic transformation(sICH)in acute ischemic stroke(AIS)treated with recombinant tissue plasminogen activator(rt-PA).Methods: The patients with acute ischemic stroke treated by intravenous thrombolysis in the Department of Neurology of Xianyang Hospital of Yan’an University from June 2020 to December 2021 were analyzed retrospectively.The venous blood routine test was completed before thrombolysis,other laboratory tests were completed within 24 hours after thrombolysis,and cranial imaging examination was performed to exclude intracranial hemorrhage.NIHSS scores before thrombolysis,1h after thrombolysis and 6h after thrombolysis were recorded.According to whether there was bleeding after thrombolysis,they were divided into HT group and non HT group.The risk factors related to HT were analyzed by univariate analysis,and the independent risk factors of HT were further analyzed by logistic regression.The receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to evaluate the performance of each independent risk factor in predicting HT,and the critical point was calculated by maximizing the Jordan index.According to whether NIHSS increased by ≥ 4 points,they were divided into sth and non sth groups.The related risk factors of sICH were analyzed by single factor analysis.Results: A total of 444 patients with intravenous thrombolysis were included.There were 77 patients with bleeding transformation(17.3%)and 20 patients with symptomatic bleeding transformation(4.5%).In univariate analysis,we found that there were significant differences between HT group and non HT group in atrial Fibrillation,neutrophil count,NLR,random blood glucose,PT,large-area cerebral infarction,serum homocysteine level,leukocyte count,NIHSS score before thrombolysis,NIHSS score 1 hour after thrombolysis,NIHSS score 6 hours after thrombolysis and Fibrinogen(P < 0.05).Multiple logistic regression analysis showed that large area cerebral infarction(OR=4.093,95% confidence interval CI= 2.196-7.625,P < 0.001);Leukocyte count(OR=1.125,95% confidence interval CI = 1.025-1.234 p = 0.013);Serum homocysteine level(OR=1.062,95%confidence interval CI=1.016-1.110 p=0.007)was an independent risk factor for HT.In univariate analysis,we also found that there were significant differences between sth group and non sth group in baseline systolic blood pressure,massive cerebral infarction,NIHSS score before thrombolysis,leukocyte count,neutrophil count,lymphocyte count,NLR,random blood glucose,PT and Fibrinogen(P < 0.05).Conclusion: Large area cerebral infarction,serum homocysteine level and leukocyte count are independent risk factors for hemorrhagic transformation after intravenous thrombolysis.