Kamal Haris, Mehta Bijal K, Ahmed Muhammad K, Kavak Katelyn S, Zha Alicia, Lail Navdeep S, Shirani Peyman, Al-Mufti Fawaz, Sawyer Robert N, Mowla Ashkan
Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
Department of Neurology, Harbor-UCLA Medical Center, Los Angeles, CA, United States of America.
J Neurol Sci. 2021 Jan 15;420:117265. doi: 10.1016/j.jns.2020.117265. Epub 2020 Dec 9.
Laboratory factors associated with hemorrhagic conversion (HC) after Intravenous thrombolysis with rtPA (IVT) for Acute Ischemic Stroke (AIS) remain nebulous despite advances in our knowledge of AIS. This study aimed to investigate the laboratory factors predisposing to HC in AIS patients receiving IVT.
We retrospectively reviewed the medical records of patients who received IV tPA for AIS at our comprehensive stroke center over a 9.6-year period. Besides age, gender, NIHSS, history of diabetes mellitus (DM), history of atrial fibrillation (Afib), we gathered their laboratory data including International Normalized Ratio (INR), lipid panel, serum albumin, serum creatinine, hemoglobin A1c (HbA1c), and admission blood glucose. Post-thrombolysis brain imagings were reviewed to evaluate for symptomatic ICH (sICH). The mean values of above mentioned laboratory data were compared between the group with sICH and patients with no sICH. Univariate and multivariate logistic regression were performed to evaluate the association of the laboratory findings with presence of sICH. sICH was defined as ICH causing an increase in NIHSS ≥4.
Of the 794 subjects in this study 51 (6.4%) had sICH. In the univariate analysis, patients who developed sICH had significantly higher NIHSS on admission (14.2 ± 5.4 vs 11.2 ± 6.5, p < .001), LDL-cholesterol (113.3 mg/dl ±36.9 vs. 101.8 mg/dl ± 38.2, p = .032), HbA1c (6.9% ± 2.3 vs. 6.1 ± 1.3, p = .003) and lower levels of Albumin (3.5 g/dl ±0.4 vs. 3.9 g/dl ± 0.5, p < .001). Furthermore, a higher prevalence of history of DM (45% vs. 21.6%, p = .020) and Afib (25.4% vs. 10.4%, p = .028) was found in subjects who developed sICH. There were no significant group differences regarding age, sex, total cholesterol, blood glucose on admission, serum creatinine or INR levels (p > .05). After adjusting for multiple covariates, lower Albumin level and and higher HbA1c were significantly associated with an increased risk for sICH development (p < .05). Chances of sICH increased by 33% for every 1 g/dl below a normal albumin level of 4.0 g/dl (p < .05).
Lower endogenous albumin level and higher HbA1c have shown to predispose to a higher risk of sICH after IVT for AIS and might be good predictors of sICH post IVT.
尽管我们对急性缺血性卒中（AIS）的认识有所进步，但与急性缺血性卒中静脉注射重组组织型纤溶酶原激活剂（rtPA）后出血转化（HC）相关的实验室因素仍不明确。本研究旨在调查接受静脉溶栓治疗的AIS患者中易发生出血转化的实验室因素。
我们回顾性分析了9.6年间在我们综合卒中中心接受静脉注射tPA治疗AIS患者的病历。除年龄、性别、美国国立卫生研究院卒中量表（NIHSS）评分、糖尿病（DM）病史、心房颤动（Afib）病史外，我们收集了他们的实验室数据，包括国际标准化比值（INR）、血脂指标、血清白蛋白、血清肌酐、糖化血红蛋白（HbA1c）和入院血糖。回顾溶栓后脑影像学检查以评估症状性脑出血（sICH）。比较sICH组和无sICH患者上述实验室数据的平均值。进行单因素和多因素逻辑回归分析以评估实验室检查结果与sICH发生之间的关联。sICH定义为导致NIHSS评分增加≥4分的脑出血。
本研究的794名受试者中，51名（6.4%）发生了sICH。在单因素分析中，发生sICH的患者入院时NIHSS评分显著更高（14.2±5.4对11.2±6.5，p<.001）、低密度脂蛋白胆固醇（113.3mg/dl±36.9对101.8mg/dl±38.2，p=.032）、HbA1c（6.9%±2.3对6.1±1.3，p=.003），且白蛋白水平更低（3.5g/dl±0.4对3.9g/dl±0.5，p<.001）。此外，发生sICH的受试者中DM病史（45%对21.6%，p=.020）和Afib病史（25.4%对10.4%，p=.028）的患病率更高。在年龄、性别、总胆固醇、入院血糖、血清肌酐或INR水平方面，两组之间无显著差异（p>.05）。在调整多个协变量后，较低的白蛋白水平和较高的HbA1c与sICH发生风险增加显著相关（p<.05）。白蛋白水平每低于正常水平4.0g/dl 1g/dl，sICH发生的几率增加33%（p<.05）。
较低的内源性白蛋白水平和较高的HbA1c已显示出在AIS静脉溶栓后易发生sICH的风险更高，可能是静脉溶栓后sICH的良好预测指标。
