Department of Neurology, West China Hospital, Sichuan University , Sichuan, China.
West China School of Medicine, Sichuan University , Sichuan, China.
Neurol Res. 2020 Nov;42(11):980-986. doi: 10.1080/01616412.2020.1796403. Epub 2020 Jul 22.
Hemorrhagic transformation (HT) is a common complication of ischemic stroke. We performed this study to determine whether aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) was related to HT, as well as compare the predictive values of AAR, ALT and AST for HT in patients with ischemic stroke.
We included ischemic stroke patients within 7 days of onset. HT was identified by a follow-up imaging examination. Univariate and multivariate logistic regression models were performed to assess the association between AAR and HT. Net reclassification index (NRI) was calculated to assess the ability of AAR, AST and ALT to reclassify risks of HT.
A total of 2042 (median age: 69 years; 63.2% males) patients were included in this study, of whom 232 (11.4%) were identified as HT. The receiver-operating characteristic curve analysis showed that the optimal cut-off value for AAR to predict HT was 1.22. Higher AAR (≥1.22) was an independent predictor associated with HT (OR 1.44, 95%CI 1.06-1.97, = 0.02) after adjusting for covariates. A U-shaped dose-effect relationship was found between AAR level and HT in logistic regression model with restricted cubic splines. In addition, adding AAR to a model containing conventional risk factors significantly improved predictive power for HT (NRI: 15.4%, = 0.027), but not for ALT (NRI: 10.3%, = 0.141) or AST (NRI: 8.3%, = 0.237).
Higher AAR was associated with an increased risk of HT after ischemic stroke. In addition, AAR might be a better biomarker for predicting HT than ALT or AST.
出血转化（HT）是缺血性脑卒中的常见并发症。我们进行这项研究旨在确定天冬氨酸氨基转移酶（AST）与丙氨酸氨基转移酶（ALT）比值（AAR）是否与 HT 相关，并比较 AAR、ALT 和 AST 对缺血性脑卒中患者 HT 的预测价值。
我们纳入了发病 7 天内的缺血性脑卒中患者。通过随访影像学检查确定 HT。采用单因素和多因素逻辑回归模型评估 AAR 与 HT 之间的关系。计算净重新分类指数（NRI）以评估 AAR、AST 和 ALT 重新分类 HT 风险的能力。
共纳入 2042 例（中位年龄：69 岁；63.2%为男性）患者，其中 232 例（11.4%）发生 HT。受试者工作特征曲线分析显示，AAR 预测 HT 的最佳截断值为 1.22。在校正协变量后，较高的 AAR（≥1.22）是与 HT 相关的独立预测因素（OR 1.44，95%CI 1.06-1.97， = 0.02）。在受限立方样条的逻辑回归模型中，AAR 水平与 HT 之间呈 U 形剂量-效应关系。此外，在包含常规危险因素的模型中添加 AAR 可显著提高 HT 的预测能力（NRI：15.4%， = 0.027），但对 ALT（NRI：10.3%， = 0.141）或 AST（NRI：8.3%， = 0.237）无影响。
较高的 AAR 与缺血性脑卒中后 HT 的风险增加相关。此外，AAR 可能是预测 HT 比 ALT 或 AST 更好的生物标志物。
