Predictive Factors for Hemorrhagic Transformation in Acute Ischemic Stroke in the REAL-World Clinical Practice.
Journal
The neurologist
ISSN: 2331-2637
Titre abrégé: Neurologist
Pays: United States
ID NLM: 9503763
Informations de publication
Date de publication:
01 May 2023
01 May 2023
Historique:
medline:
8
5
2023
pubmed:
1
9
2022
entrez:
31
8
2022
Statut:
epublish
Résumé
Few data exists on predictive factors of hemorrhagic transformation (HT) in real-world acute ischemic stroke patients. The aims of this study were: (i) to identify predictive variables of HT (ii) to develop a score for predicting HT. We retrospectively analyzed the clinical, radiographic, and laboratory data of patients with acute ischemic stroke consecutively admitted to our Stroke Unit along two years. Patients with HT were compared with those without HT. A multivariate logistic regression analysis was performed to identify independent predictors of HT on CT scan at 24 hours to develop a practical score. The study population consisted of 564 patients with mean age 77.5±11.8 years. Fifty-two patients (9.2%) showed HT on brain CT at 24 hours (4.9% symptomatic). NIHSS score ≥8 at Stroke Unit admission (3 points), cardioembolic etiology (2 points), acute revascularization by systemic thrombolysis and/or mechanical thrombectomy (1 point), history of previous TIA/stroke (1 point), and major vessel occlusion (1 point) were found independent risk factors of HT and were included in the score (Hemorrhagic Transformation Empoli score (HTE)). The predictive power of HTE score was good with an AUC of 0.785 (95% CI: 0.749-0.818). Compared with 5 HT predictive scores proposed in the literature (THRIVE, SPAN-100, MSS, GRASPS, SITS-SIC), the HTE score significantly better predicted HT. NIHSS score ≥8 at Stroke Unit admission, cardioembolism, urgent revascularization, previous TIA/stroke, and major vessel occlusion were independent predictors of HT. The HTE score has a good predictive power for HT. Prospective studies are warranted.
Sections du résumé
BACKGROUND
BACKGROUND
Few data exists on predictive factors of hemorrhagic transformation (HT) in real-world acute ischemic stroke patients. The aims of this study were: (i) to identify predictive variables of HT (ii) to develop a score for predicting HT.
METHODS
METHODS
We retrospectively analyzed the clinical, radiographic, and laboratory data of patients with acute ischemic stroke consecutively admitted to our Stroke Unit along two years. Patients with HT were compared with those without HT. A multivariate logistic regression analysis was performed to identify independent predictors of HT on CT scan at 24 hours to develop a practical score.
RESULTS
RESULTS
The study population consisted of 564 patients with mean age 77.5±11.8 years. Fifty-two patients (9.2%) showed HT on brain CT at 24 hours (4.9% symptomatic). NIHSS score ≥8 at Stroke Unit admission (3 points), cardioembolic etiology (2 points), acute revascularization by systemic thrombolysis and/or mechanical thrombectomy (1 point), history of previous TIA/stroke (1 point), and major vessel occlusion (1 point) were found independent risk factors of HT and were included in the score (Hemorrhagic Transformation Empoli score (HTE)). The predictive power of HTE score was good with an AUC of 0.785 (95% CI: 0.749-0.818). Compared with 5 HT predictive scores proposed in the literature (THRIVE, SPAN-100, MSS, GRASPS, SITS-SIC), the HTE score significantly better predicted HT.
CONCLUSIONS
CONCLUSIONS
NIHSS score ≥8 at Stroke Unit admission, cardioembolism, urgent revascularization, previous TIA/stroke, and major vessel occlusion were independent predictors of HT. The HTE score has a good predictive power for HT. Prospective studies are warranted.
Identifiants
pubmed: 36044909
doi: 10.1097/NRL.0000000000000462
pii: 00127893-202305000-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
150-156Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Tan S, Wang D, Liu M, et al. Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis. J Neurol. 2014;261:905–912.
Lindley RI, Wardlaw JM, Sandercock PA, et al. Frequency and risk factor for spontaneous hemorrhagic transformation of cerebral infarction. J Stroke Cerebrovasc Dis. 2004;6:235–246.
Paciaroni M, Agnelli G, Corea F, et al. Early hemorrhagic transformation of brain infarction: rate; predictive factor and influence on clinical outcome. Results of a prospective multicenter study. Stroke. 2008;39:2249–2256.
Arba F, Rinaldi C, Caimano D, et al. Blood-brain barrier disruption and hemorrhagic transformation in acute ischemic stroke: systematic review and meta-analysis. Front Neurol. 2021;11:594613. doi: 10.3389/fneur.2020.594613
doi: 10.3389/fneur.2020.594613
Thomas SE, Plumber N, Venkatapathappa P, et al. A review of risk factors and predictors for hemorrhagic transformation in patients with acute ischemic stroke. Int J Vasc Med. 2021;2021:4244267.
Yaghi S, Willey JZ, Cucchiara B, et al. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48:343–361.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24:35-41.
Hart RG, Diener HC, Coutts SB, et al. Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429–438.
Flint AC, Faigeles BS, Cullen SP, et al. On behalf of the VISTA Collaboration. TRIVE score predicts ischemic stroke outcomes and thrombolytic hemorrhage risk in VISTA. Stroke. 2013;44:3365–3369.
Saposnik G, Guzik AK, Reeves M, et al. Stroke Prognostication Using Age and NIH Stroke Scale: SPAN-100. Neurology. 2013;80:21–28.
Cucchiara B, Tanne D, Levine SR, et al. A risk score to predict intracranial hemorrage after recombinant tissue plasminogen activator for acute ischemic stroke. J Stroke Cerebrovasc Dis. 2008;17:331–333.
Mazya M, Egido JA, Ford GA, et al. For the SITS Investigators. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score [published correction appears in Stroke. 2012; 43: e102]. Stroke. 2012;43:1524–1531.
Menon BK, Saver JL, Prabhakaran S, et al. Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Stroke. 2012;43:2293–2299.
Andrade JBC, Mohr JP, Lima FO, et al. Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts’ opinion. Arq Neuropsiquiatr. 2020;78:390–396.
Elsaid N, Mustafa W, Saied A. Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis. Neuroradiol J. 2020;33:118–133.
Whiteley WN, Slot KB, Fernandes P, et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies. Stroke. 2012;43:2904–2909.
Świtońska M, Piekuś-Słomka N, Słomka A, et al. Neutrophil-to-lymphocyte ratio and symptomatic hemorrhagic transformation in ischemic stroke patients undergoing revascularization. Brain Sci. 2020;10:771.
Wang Y, Qiu K, Song Q, et al. AST to ALT ratio and risk of hemorrhagic transformation in patients with acute ischemic stroke. Neurol Res. 2020;42:980–986.
Tan G, Yuan R, Wei C, et al. Serum magnesium but not calcium was associated with hemorrhagic transformation in stroke overall and stroke subtypes: a case-control study in China. Neurol Sci. 2018;39:1437–1443.
Liu J, Wang Y, Jin Y, et al. Prediction of hemorrhagic transformation after ischemic stroke: development and validation study of a novel multi-biomarker model. Front Aging Neurosci. 2021;13:667934.
Van Kranendonk KR, Treurniet KM, Boers AMM, et al. MR CLEAN Investigators. Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion. J Neurointerv Surg. 2019;11:464–468.
Arba F, Piccardi B, Palumbo V, et al. Blood-brain barrier leakage and hemorrhagic transformation: The Reperfusion Injury in Ischemic StroKe (RISK) study. Eur J Neurol. 2021;28:3147–3154.
Lou M, Safdar A, Mehdiratta M, et al. The HAT Score: a simple grading scale for predicting hemorrhage after thrombolysis. Neurology. 2008;71:1417–1423.
Strbian D, Engelter S, Michel P, et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score. Ann Neurol. 2012;71:634–641.
Marsh EB, Llinas RH, Schneider ALC, et al. Predicting hemorrhagic transformation of acute ischemic stroke: prospective validation of the HeRS Score. Medicine (Baltimore). 2016;95:2430.
De Andrade JBC, Mohr JP, Lima FO, et al. Predicting hemorrhagic transformation in patients not submitted to reperfusion therapies. J Stroke Cerebrovasc Dis. 2020;29:104940.
Kalinin MN, Khasanova DR, Ibatullin MM. The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke. BMC Neurol. 2017;17:177.
Luo S, Zhuang M, Zeng W, et al. Intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy: a systematic review and meta-analysis of 19 studies. J Am Heart Assoc. 2016;20 5:e003242.
Tsivgoulis G, Katsanos AH, Zand R, et al. Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke: a systematic review and meta-analysis. J Neurol. 2017;264:1227–1235.
Frey BM, Boutitie F, Cheng B, et al. WAKE-UP investigators. Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. Neurol Res Pract. 2020;20:40.
Honig A, Percy J, Sepehry AA, et al. Hemorrhagic Transformation in Acute Ischemic Stroke: A Quantitative Systematic Review. J Clin Med. 202;11:1162.
Li W, Xing X, Wen C, et al. Risk factors and functional outcome were associated with hemorrhagic transformation after mechanical thrombectomy for acute large vessel occlusion stroke. J Neurosurg Sci. 2020. Dec 15. doi: 10.23736/S0390-5616.20.05141-3. [Online ahead of print].
doi: 10.23736/S0390-5616.20.05141-3
Ramos-Araque ME, Chavarría-Miranda A, Gómez-Vicente B, et al. Oral anticoagulation and risk of symptomatic hemorrhagic transformation in stroke patients treated with mechanical thrombectomy: data from the nordictus registry. Front Neurol. 2020;11:594251.
Gill D, Baheerathan A, Aravind A, et al. Severe hemorrhagic transformation after thrombolysis for acute ischemic stroke prevents early neurological improvement. J Stroke Cerebrovasc Dis. 2016;25:2232–2236.
Ge WQ, Chen J, Pan H, et al. Analysis of risk factors increased hemorrhagic transformation after acute ischemic stroke. J Stroke Cerebrovasc Dis. 2018;27:3587–3590.