Horsch Alexander D, Bennink Edwin, van Seeters Tom, Kappelle L Jaap, van der Graaf Yolanda, Mali Willem P T M, de Jong Hugo W A M, Velthuis Birgitta K, Dankbaar Jan Willem
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Neurology, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Cerebrovasc Dis. 2018;45(1-2):26-32. doi: 10.1159/000485043. Epub 2018 Jan 8.
Hemorrhagic transformation (HT) in acute ischemic stroke can occur as a result of reperfusion treatment. While withholding treatment may be warranted in patients with increased risk of HT, prediction of HT remains difficult. Nonlinear regression analysis can be used to estimate blood-brain barrier permeability (BBBP). The aim of this study was to identify a combination of clinical and imaging variables, including BBBP estimations, that can predict HT.
From the Dutch acute stroke study, 545 patients treated with intravenous recombinant tissue plasminogen activator and/or intra-arterial treatment were selected, with available admission extended computed tomography (CT) perfusion and follow-up imaging. Patient admission treatment characteristics and CT imaging parameters regarding occlusion site, stroke severity, and BBBP were recorded. HT was assessed on day 3 follow-up imaging. The association between potential predictors and HT was analyzed using univariate and multivariate logistic regression. To compare the added value of BBBP, areas under the curve (AUCs) were created from 2 models, with and without BBBP.
HT occurred in 57 patients (10%). In univariate analysis, older age (OR 1.03, 95% CI 1.006-1.05), higher admission National Institutes of Health Stroke Scale (NIHSS; OR 1.13, 95% CI 1.08-1.18), higher clot burden (OR 1.28, 95% CI 1.16-1.41), poor collateral score (OR 3.49, 95% CI 1.85-6.58), larger Alberta Stroke Program Early CT Score cerebral blood volume deficit size (OR 1.26, 95% CI 1.14-1.38), and increased BBBP (OR 2.22, 95% CI 1.46-3.37) were associated with HT. In multivariate analysis with age and admission NIHSS, the addition of BBBP did not improve the AUC compared to both independent predictors alone (AUC 0.77, 95% CI 0.71-0.83).
BBBP predicts HT but does not improve prediction with age and admission NIHSS.
急性缺血性卒中的出血性转化（HT）可能是再灌注治疗的结果。虽然对于HT风险增加的患者可能有必要延迟治疗，但HT的预测仍然困难。非线性回归分析可用于估计血脑屏障通透性（BBBP）。本研究的目的是确定包括BBBP估计值在内的临床和影像变量的组合，以预测HT。
从荷兰急性卒中研究中，选取545例接受静脉注射重组组织型纤溶酶原激活剂和/或动脉内治疗的患者，这些患者有入院时的增强计算机断层扫描（CT）灌注检查及随访影像资料。记录患者入院时的治疗特征以及关于闭塞部位、卒中严重程度和BBBP的CT影像参数。在第3天的随访影像中评估HT情况。使用单因素和多因素逻辑回归分析潜在预测因素与HT之间的关联。为比较BBBP的增加值，从包含和不包含BBBP的两个模型创建曲线下面积（AUC）。
57例患者（10%）发生HT。在单因素分析中，年龄较大（比值比[OR]1.03，95%置信区间[CI]1.006 - 1.05）、入院时美国国立卫生研究院卒中量表（NIHSS）评分较高（OR 1.13，95% CI 1.08 - 1.18）、血栓负荷较高（OR 1.28，95% CI 1.16 - 1.41）、侧支循环评分较差（OR 3.49，95% CI 1.85 - 6.58）、阿尔伯塔卒中项目早期CT评分脑血容量缺损面积较大（OR 1.26，95% CI 1.14 - 1.38）以及BBBP增加（OR 2.22，95% CI 1.46 - 3.37）与HT相关。在对年龄和入院NIHSS进行多因素分析时，与单独的两个独立预测因素相比，加入BBBP并未改善AUC（AUC 0.77，95% CI 0.71 - 0.83）。
BBBP可预测HT，但在年龄和入院NIHSS基础上并不能改善预测效果。
