Andrade Joao Brainer Clares, Mohr Jay P, Lima Fabricio Oliveira, de Carvalho Joao José Freitas, Barros Levi Coelho Maia, Nepomuceno Camila Rodrigues, Ferrer Joao Victor Cabral Correia, Silva Gisele Sampaio
Department of Neurology, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP 04039-001, Brazil; Columbia University, Doris and Stanley Tananbaum Stroke Center, USA.
Columbia University, Doris and Stanley Tananbaum Stroke Center, USA.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104898. doi: 10.1016/j.jstrokecerebrovasdis.2020.104898. Epub 2020 May 13.
Hemorrhagic transformation (HT) is a common neurological complication after ischemic stroke. The influence of symptomatic HT upon clinical outcomes post-stroke is well established, however, the role of asymptomatic HT upon prognosis is still unclear. We aimed to analyze the relationship between HT, clinical complications and outcomes in patients not submitted to reperfusion therapies (RT).
We included 448 randomly selected patients admitted with acute ischemic stroke to a tertiary hospital stroke unit from 2015 to 2017. Patients submitted to RT were excluded. All patients were evaluated with computed tomography (CT) at admission and within 7 days from the initial CT. Patients with HT were divided into two groups: symptomatic and asymptomatic cases based on the ECASS II definition. A good clinical outcome was defined as a modified Rankin Scale (mRS) 0-2 at discharge.
A total of 95 patients (21.2%) had HT (51 asymptomatic and 44 symptomatic). Age, NIHSS at admission and symptomatic HT were associated with a higher risk of developing pneumonia and seizures during hospitalization. Symptomatic HT was also associated with a prolonged length of hospitalization and death and inversely associated with good clinical outcomes at discharge (OR 0.96, 95% CI 0.94-0.98, p<0.001). In an adjusted analysis, even asymptomatic HT was independently associated with worse clinical outcomes at discharge (mRS 4-6) (OR 5.99, 95% CI 1.83-19.58, p = 0.003).
Symptomatic HT is associated with a higher risk of clinical complications, prolonged hospitalization, death and worse clinical outcome at discharge. Furthermore, even patients with asymptomatic HT had a higher chance of worse clinical outcomes at discharge.
出血性转化（HT）是缺血性卒中后常见的神经并发症。有症状的HT对卒中后临床结局的影响已得到充分证实，然而，无症状HT对预后的作用仍不清楚。我们旨在分析未接受再灌注治疗（RT）的患者中HT、临床并发症与结局之间的关系。
我们纳入了2015年至2017年随机选取的448例因急性缺血性卒中入住三级医院卒中单元的患者。排除接受RT的患者。所有患者在入院时及首次CT检查后7天内均接受计算机断层扫描（CT）评估。根据ECASS II定义，HT患者分为两组：有症状和无症状病例。良好的临床结局定义为出院时改良Rankin量表（mRS）评分为0 - 2分。
共有95例患者（21.2%）发生HT（51例无症状，44例有症状）。年龄、入院时美国国立卫生研究院卒中量表（NIHSS）评分及有症状的HT与住院期间发生肺炎和癫痫的风险较高相关。有症状的HT还与住院时间延长和死亡相关，且与出院时良好的临床结局呈负相关（比值比[OR]0.96，95%置信区间[CI]0.94 - 0.98，p<0.001）。在多因素分析中，即使是无症状的HT也与出院时较差的临床结局（mRS 4 - 6）独立相关（OR 5.99，95% CI 1.83 - 19.58，p = 0.003）。
有症状的HT与临床并发症风险较高及住院时间延长、死亡和出院时较差的临床结局相关。此外，即使是无症状HT患者出院时出现较差临床结局的可能性也较高。
