Clinical Characteristics And Risk Factors Of Hemorrhage Transformation In Aged Patients With Cerebral Infarction

Objective:Age is an independent risk factor for cerebral infarction(CI)and hemorrhagic transformation(HT).The purpose of this study was to investigate the clinical characteristics,risk and related influencing factors of HT in first-time CI patients aged 80 years and older treated with non-vascular recanalization.Methods: 134 elderly patients(≥ 80 years old)with first-episode CI who were hospitalized in the neurology ward of Qingdao University Affiliated Hospital from January 1,2018 to October 31,2020 and who did not receive vascular recanalization therapy were retrospectively collected as the elderly group.A total of 292 CI patients aged60～79 years old who were hospitalized during the same period and met the inclusion and exclusion criteria were collected as the control group.The general data,risk factors of stroke,clinical manifestations,TOAST classification,proportion of HT,treatment and prognosis,as well as imaging characteristics of cerebral small vessel disease(CSVD)were analyzed and compared between the two groups.CSVD signs include enlarged perivascular space(EPVS),cerebral microbleeds(CMB),white matter hyperintensity(WMH),lacunar.Furthermore,the elderly group was further divided into the HT group(n= 33)and the non-HT group(n = 101)according to the presence or absence of HT within2 weeks.The general date,stroke risk factors,blood test results,infarct size,TOAST classification,CSVD signs,treatment and prognosis of the two groups were compared.Multivariate logistic regression analysis and ROC curve were used to analyze the independent risk factors of HT.Results: 1.In the elderly group,atrial fibrillation(AF)(26.1% vs.9.2%,P < 0.001),coronary heart disease(38.1% vs.25.0%,P = 0.006),myocardial infarction(6.7% vs.1.7%,P = 0.007)were significantly higher than the control group,The prevalence of hypertension(66.4% vs.76.4%),diabetes(19.4% vs.40.1%),hyperlipidemia(23.1% vs.33.2%),smoking(31.3% vs.40.4%),alcohol consumption(14.9% vs.30.1%)was lower than that of control group(P < 0.05),and the differences were statistically significant.2.In terms of clinical manifestations,compared with the control group,the proportion of consciousness disturbance(11% vs.5.5%,P = 0.035)and the incidence of HT(24.6% vs.14.7%,P = 0.013)were higher in the elderly group,with statistically significant differences.However,the proportion of symptomatic intracranial hemorrhage(s ICH)between the two groups(2.2% vs.1.4%,P = 0.512)showed no significant difference.The proportion of m RS ≤ 2(90 ± 7 days)after discharge in the elderly was lower(68.7% vs.84.2%,P = 0.029),and the difference was statistically significant.3.The proportion of CE was higher in the elderly group(23.9% vs.7.9%,P < 0.001),indicating a significant difference.The infarction area and CMBs grade of the aged group were higher than those of the control group,with statistical difference(P < 0.05).The overall CSVD burden,WMH and EPVS of the aged group were higher than those of the control group,but there was no statistical difference.4.The proportion of AF in HT group(48.5% vs.18.8%,P = 0.001)and the level of D-dimer(540 ng/m L vs.380 ng/ml,P = 0.048)were significantly higher than those in non-HT group.5.In TOAST classification,CE(51.5% vs.14.9%,P < 0.001)was higher in the HT group than in the non-HT group,while small-artery occlusion lacunar(SAA)(0.0% vs.23.8%,P = 0.002)and large-artery atherosclerosis(LAA)(21.2% vs.43.6%,P = 0.022)were lower than in the non-HT group.Compared with the non-HT group,imaging examination showed that the proportion of large area cerebral infarction(39.4% vs.13.9%)and CMBs grade were highter in HT group,while the EPVS score was lower,P < 0.05.The WMH and CSVD scores of HT group were higher,but P > 0.05.6.There was no statistically significant difference in antithrombotic therapy between the HT group and the non-HT group(P = 0.183);The proportion of MRS ≤ 2 at 90 ± 7 days after discharge in HT group was lower than that in control group(57.6% vs.73.3%,P =0.889).7.Multivariate Logistic regression analysis revealed that CE(OR = 3.197,95%CI:1.135～9.002;P = 0.028),CMBs grading(OR = 2.409,95% CI: 1.309～4.435;P = 0.005),infarct size(OR = 2.116,95% CI: 1.088～4.116;P = 0.027)was an independent risk factor for HT in elderly CI patients.ROC efficiency curve showed infarction area(AUC = 0.690,95%CI: 0.586～0.795),CMBs grading(AUC = 0.665,95%CI: 0.558～0.773),CE(AUC =0.713,95%CI: 0.570～0.797)had predictive effect on HT in elderly patients with CI,P <0.05.Conclusions:1.Compared with CI patients aged 60-79 years,the proportion of CE in TOAST classification and large cerebral infarction was higher in the elderly group,and the CMBs grade was higher.2.In the elderly group,the proportion of HT within 2 weeks was higher compared with the control group,but s ICH was not significantly increased.3.CE,CMBs grade and infarct size are independent risk factors for HT in elderly CI patients,and can predict the risk of HT.4.The increased incidence of CE and CMBs may be the main factors of increased HT in elderly CI patients.Therefore,age alone should not be a barrier to treatment in the patients of acute ischemic stroke,and risk stratification in the elderly population is needed.However,risk stratification can be carried out according to etiological classification and small vascular signs to further ensure the safety of treatment.