The Study Of Risk Factors Of Spontaneous Hemorrhagic Transformation In Acute Cerebral Infarction And Its Relationship With The Prognosis

Objective: To investigate the risk factors of spontaneoushemorrhagic transformation after cerebral infarction and its relationshipwith the prognosis. Materials and methods:1.We prospectivelyregistered consecutive cases of acute ischemic stroke at the neurologywards of the Sichuan Provincial People’s Hospital from November01,2011to July31,2012. Patients with ischemic stroke within7days ofsymptom onset were included; all the relevant clinic and laboratoryexamination dates which influencing spontaneous hemorrhagictransformation were collected. Recheck brain CT or MRI within3daysafter admission or when neurological deficit deterioration happened.Spontaneous hemorrhagic transformation was judged when recheck brainCT scan or MRI had intracranial hemorrhages. According to the recheckbrain CT scan or MRI with or without intracranial hemorrhage, patientswere divided into hemorrhagic transformation (HT) group or non-HT(NHT) group.2. Following up at the end of3month after patient’ssymptom onset, got the information about prognosis. The main content ofthe follow up include:1). Survival state2). Disability state. Disabilitywas judged by Modified Rankin Scale (MRS), MRS≥3points wasdefined to disability, MRS＜3points was defined to non-disability.3. Measurement data were expressed as Mean±SD or median. Differencesamong groups were analyzed by Student t test when the data meet normaldistribution. If the dates meet non-normal distribution, rank sum test wereused. Qualitative data were described as percentages and analyzed usingChi-square (χ2) test. Influencing factors were analyzed by usingunivariate analysis; get the risk factors about spontaneous hemorrhagictransformation. When univariate analyses show P≤0.10, multivariatelogistical regression was utilized to detect the independent impact factorsof spontaneous hemorrhagic transformation. For multivariate logisticalregression, if the dependent variable was dichotomization classificationvariable, Binary Logistic regression was used. Influencing factors aboutdeath/dependence (death) when patient’s symptom onset3month, wereanalyzed by using univariate analysis. When univariate analyses showP≤0.10, multivariate logistical regression was utilized to detect theindependent impact factors of death/dependence (death) when patient’ssymptom onset3month. Results:1.337cases were included,195caseswere male（57.9%）；142cases were female（42.1%）；The age range ofthe cases was32-97years old（67.8±12.7）；All of337patients,44casesoccurred in spontaneous hemorrhagic transformation, accounting for13.1%;293cases did not occur in spontaneous hemorrhagictransformation, accounting for86.9%.2. Most spontaneous hemorrhagictransformation occurred within7days. Bleeding sites were located in the center or around the infarct area. The cerebral cortex hemorrhageoccupied a maximum proportion (47.7%).3. Atrial fibrillation history,body mass index, admission blood glucose were statistically significantbetween the two groups. Multivariate Logistic regression analysisdemonstrated that admission blood glucose (OR1.139，95%CI1.007-1.289), atrial fibrillation history (OR3.166，95%CI1.034-9.693)were independent predictors of spontaneous hemorrhagic transformationin ischemic stroke without thrombolytic therapy. At the end of3monthafter patient’s symptom onset, the follow up showed the difference of twogroups had no statistically significant.4. The volume of hematoma wassmall in spontaneous hemorrhagic transformation. After actively adjustthe treatment, the neurological deficit had no deterioration.5.Spontaneous hemorrhagic transformation wasn’t the risk factor ofdeath/dependence on3month after symptom onset for ischemic strokepatients (OR1.69，95%CI0.462-2.960). Multivariate Logistic regressionanalysis demonstrated that age (OR1.054，95%CI1.021-1.087), gender(OR2.131，95%CI1.151-3.945) and the NIHSS when admission (OR1.275,95%CI1.174-1.384) were independent predictors ofdeath/dependence at3months after ischemic stroke attacked.Spontaneous hemorrhagic transformation wasn’t the risk factor of deathafter patient’s symptom onset for3month. Multivariate Logisticregression analysis demonstrated that age (OR1.066,95%CI1.020～ 1.114), BMI (OR0.952,95%CI0.910～0.997) and the NIHSS whenadmission (OR1.145,95%CI1.077～1.217) were independent predictorsof death at3months after ischemic stroke attacked. Conclusion:1.Theincidence of spontaneous hemorrhagic transformation in cerebralinfarction patients without thrombolytic therapy is low.2. Aggressiverechecked brain CT or MRI scan should be done when the patients have ahigh risk of spontaneous hemorrhagic transformation, especially within7days.3. When an ischemic stroke patient had a high level of bloodglucose and atrial fibrillation history on admission, it would be alert theoccurrence of spontaneous hemorrhagic transformation.4. Detectedspontaneous hemorrhagic transformation promptly and adjust therapy intime, it wouldn’t have harmful effects to prognosis.