Prospective Study On Risk Factors For Hemorrhagic Transformation After Cerebral Infarction

Background and ObjectiveHemorrhagic transformation (HT) is frequently seen in acute ischemic stroke patients, which can lead to the clinical symptom deterioration and cause conflicts in the treatment of the stroke. To prevent this phenomenon from happening, careful study of risk factors for HT in acute ischemic stroke patients and choosing proper treatment for these patients is necessary. Patients in different conditions carry different risks for HT. Most researches studied risk factors for HT retrospectively, using single factor analysis. It seems that they may not able to show the real risk for HT. The aim of this study was to study the risk factors for HT after acute ischemic stroke prospectively and help make a better choice for the thrombolytic therapy.Materials and Methods1. Research objectivePatients treated by the First affiliated hospital of Zhengzhou University within7days of with symptom of acute cerebral infarction onset between March2011and March2012were prospectively registered. Inclusion criteria:1) Meeting the diagnostic criteria of cerebral infarction in the fourth National Cerebrovascular Disease Conference.2) Time from symptoms onset to admission less than one week.3) Having a CT or MRI check for a second time within two weeks from symptoms onset. Exclusion criteria:1) Patients with any neurological deficits before this accident.2) Patients not having a CT or MRI check for a second time within two weeks from symptoms onset.3) Patients with severe liver or kidney disease, or malignant neoplasm.2. MethodCandidate variables were selected among baseline variables. Candidate variables were selected according to the prior systematic analysis of risk factors for HT. Candidate variables were age, sex, history of hypertension, history of diabetes, history of smoking, history of drinking, atrial fibrillation at baseline, systolic blood pressure at baseline, diastolic blood pressure at baseline, level of consciousness at baseline, neurological deficits at baseline, blood glucose at baseline, serum total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein at baseline, platelet count, Stroke etiology, ischemic changes on CT/MRI, time from symptom onset to treatment. Patients were divided into HT group and none HT group according to EC ASS criteria, and the HT group into HI (hemorrhagic infarction) and PH (parenchyma hemorrhage).3. Statistical analysisThe data were analyzed using Software SPSS19.0.The risk for HT was investigated using single factors analysis and multiple logistic regression analysis. The difference was statistically significant as P＜0.1in the single factors analysis, and P＜0.05in the multiple logistic regression analysis, all the analysis were two-sided test. ResultsA total of consecutive865acute cerebral infarction patients were included, and55cases were diagnosed as HT, including47HT and8PH.1. General characteristic2. Rate of HT in the total and rate of HT by different TOAST typeThe rate HT of total number of patients was6.4%, and16.6%for LAA (large artery atherosclerosis)9.5%for CE (cardioembolism),3.86%for SAA (Small artery atherosclerosis),1.75%for UND (Stroke of undermined cause)(x2=32.80, P＜0.05)3. Single factors analysisSingle factors analysis showed Single factors analysis showed significant (P＜0.1) differences in the age, level of consciousness at baseline, neurological deficits at baseline, serum glucose at baseline, platelet count＜200×109/L, large infarction, atrial fibrillation at baseline, high systolic blood pressure at baseline.4. Multiple logistic regression analysis for HTMultiple logistic regression analysis showed that moderate neurological deficits (RR=3.23,95%CI1.31-7.99),severe neurological deficits(RR=9.00,95%CI2.17-37.31) atrial fibrillation (OR=3.62,95%CI1.11-12.82), high blood glucose on admission (OR=2.016,95%CI1.01-4.03)), blood platelet count lower than200×109/L(OR=2.403,95%CI1.09-5.28) were independent risk factors(P＜0.05) for HT.5. Multiple logistic regression analysis for HI and PH5.1Multiple logistic regression analysis showed that moderate neurological deficits (RR=3.89,95%CI1.52-9.93), severe neurological deficits (RR=6.58,95%CI1.50-28.94), high blood glucose on admission (OR=2.36,95%CI1.14-4.89), blood platelet count lower than200×109/L (OR=2.40,95%CI1.04-5.53) were independent risk factors (P＜0.05) for HI.5.2Multiple logistic regression analysis showed that severe neurological deficits (RR=24.81,95%CI3.50-175.66) atrial fibrillation (OR=3.62,95%CI1.11-12.82) were independent risk factors (P<0.05) for PH.Conclusions1. Patients of LAA and CE carry a higher risk for HT.2. Moderate and serious neurological deficits, moderate level of consciousness, atrial fibrillation, high blood glucose on admission and blood platelet count lower than200x109/L are independent risk factors for HT.