Universidade Federal de São Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP, Brazil; Columbia University, Doris and Stanley Tananbaum Stroke Center, 710 W 168th St. Neurological Institute of New York. 6TH Floor. NI 614, 10032. New York City, NY, USA.
Columbia University, Doris and Stanley Tananbaum Stroke Center, 710 W 168th St. Neurological Institute of New York. 6TH Floor. NI 614, 10032. New York City, NY, USA.
J Clin Neurosci. 2022 Jul;101:9-15. doi: 10.1016/j.jocn.2022.04.030. Epub 2022 Apr 29.
Hemorrhagic transformation (HT) is a dreaded complication in stroke patients who were treated or not with recombinant tissue plasminogen activator (tPA). There are many predictive scores of HT, but all of them included patients treated with tPA. Molecular effects of tPA and clinical aspects of eligible patients for tPA therapy may imply specific HT's risk factors. We aimed to describe HT's characteristics and risk factors in patients treated or not with tPA.
We included 1565 consecutive stroke patients admitted to a Comprehensive Stroke Center, from 2015 to 2017. All included patients underwent a follow-up neuroimaging within seven days after admission. From a logistic regression model, we derived a score based on the beta-coefficients. The accuracy of the models was attested by Receiver Operating Characteristic analysis.
Low ASPECTS, blood glucose ≥ 180 mg/dL, tPA treatment, and cardio-aortic embolism were predictors of HT. Male sex, leukoaraiosis, and hyperdense MCA sign were associated with HT in non-treated patients. Diastolic blood pressure ≥ 105 mmHg was a risk factor only in non-treated patients. The cutoff of our predictive score of HT was higher in patients not treated with tPA (5 vs 2 points).
High arterial blood pressure was associated with HT only in patients treated with tPA. Different cutoffs and accuracy measurements suggest that scoring systems derived from patients treated with tPA may not be efficient to predict HT in non-treated patients. Further directions indicate considering the use of reperfusion therapies to select the most accurate predictive variables of HT.
出血性转化（HT）是接受或未接受重组组织型纤溶酶原激活剂（tPA）治疗的中风患者的一种可怕并发症。有许多 HT 的预测评分，但它们都包括接受 tPA 治疗的患者。tPA 的分子效应和适合 tPA 治疗的患者的临床方面可能意味着特定的 HT 危险因素。我们旨在描述接受或未接受 tPA 治疗的患者的 HT 特征和危险因素。
我们纳入了 2015 年至 2017 年间在综合卒中中心连续收治的 1565 例卒中患者。所有纳入的患者在入院后七天内进行了随访神经影像学检查。我们从逻辑回归模型中得出了一个基于 beta 系数的评分。通过接受者操作特征分析验证了模型的准确性。
低 ASPECTS、血糖≥180mg/dL、tPA 治疗和心源性栓子是 HT 的预测因素。男性、白质疏松和 MCA 高密度征与未接受治疗的患者的 HT 相关。舒张压≥105mmHg 仅在未接受治疗的患者中是一个危险因素。我们的 HT 预测评分在未接受 tPA 治疗的患者中，其临界值更高（5 分与 2 分）。
仅在接受 tPA 治疗的患者中，高动脉血压与 HT 相关。不同的临界值和准确性测量表明，源自接受 tPA 治疗的患者的评分系统可能无法有效地预测未接受治疗的患者的 HT。进一步的方向表明，考虑使用再灌注治疗来选择 HT 最准确的预测变量。
