Study On Factors Related To Hemorrhagic Transformation After Acute Cerebral Infarction

Objective: As a common complication of cerebral infarction,hemorrhagic transformation often indicates worse clinical outcome.The aim of this study was to explore the influencing factors related to hemorrhagic transformation in patients with acute cerebral infarction.Methods: A retrospective collection of patients with hemorrhagic transformation after acute cerebral infarction who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University from 2018 to 2020 were collected as the hemorrhagic transformation group.And the matched patients with acute cerebral infarction without hemorrhagic transformation were collected at the same time.All patients did not receive reperfusion therapy.The clinical data of the two groups were compared.Single factor and Logistic regression models were used to analyze the factors related to hemorrhagic transformation.After excluding patients with atrial fibrillation,univariate analysis and multivariate logistic regression analysis were performed to explore the factors related to hemorrhagic transformation.Finally,univariate analysis explored whether anticoagulation therapy and antiplatelet therapy were related to hemorrhagic transformation in patients with low PNR.Results: We collected a total of 137 patients,including 61 patients in the hemorrhagic transformation group and 76 patients in the non-hemorrhagic transformation group.Univariate analysis found differences in the history of atrial fibrillation,admission NIHSS score,hypersensitive C-reactive protein,glycosylated hemoglobin,absolute value of monocytes,platelet-to-neutrophil ratio(PNR)and platelet hematocrit between the two groups.The difference was statistically significant.Logistic regression analysis showed that PNR,atrial fibrillation,and the admission NIHSS score were independently associated with hemorrhagic transformation(P<0.05).By drawing the ROC curve,it was found that the area under the curve(AUC)of PNR predicting hemorrhagic transformation after cerebral infarction was 0.808,95% CI was0.735～0.882.When the cutoff value of PNR was 50.4765,the sensitivity was70.5% and the specificity was 82.9%.After stratifying the PNR with 50.4765,logistic regression analysis was performed again.The risk of hemorrhagic transformation in patients with low PNR was 12.995 times that of the high PNR group.In patients with non-atrial fibrillation,only the PNR of the hemorrhagic transformation group was found to be lower than that of the non-hemorrhagic transformation group,and the absolute value of monocytes was higher than that of the non-hemorrhagic transformation group.After logistic analysis,PNR was still independently related to hemorrhagic transformation.Taking patients with low PNR as research object,there was no statistical difference between anticoagulant therapy and antiplatelet therapy.Conclusions:1.PNR is a possible predictor of hemorrhagic transformation,and patients with low PNR have a higher risk of hemorrhagic transformation.When PNR≤50.4765,anticoagulation therapy and antiplatelet therapy do not increase the risk of hemorrhagic transformation.2.Atrial fibrillation is related to hemorrhagic transformation,and patients with the history of atrial fibrillation have a higher risk of hemorrhagic transformation.3.The admission NIHSS score is a risk factor for hemorrhagic transformation.Patients with high admission NIHSS scores are at higher risk of hemorrhagic transformation.But when it comes to non-atrial fibrillation patients,the NIHSS score has nothing to do with the occurrence of hemorrhagic transformation.It may be related to the small sample size of this study and the milder condition of the patients.