Introduction: intracerebral hemorrhagic transformation (HT) is a multifactorial phenomenon in which ischemic brain tissue converts into a hemorrhagic lesion with blood vessel leakage, and can significantly contribute to additional brain injury after stroke. Understanding mechanisms and identifying predictors of HT may contribute to improve clinical outcomes in stroke patients.
Hypothesis: to evaluate clinical predictors of HT in non-lacunar ischemic stroke patients.
Methods: patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic medical records. Acute SBP, DBP and PP were obtained in the emergency room and HT was evaluated with on-admission and one-week CT or MRI. Predictors of HT were identified by multivariate analysis. Exclusion criteria: TIA, lacunar stroke and patients without one-week CT or MRI.
Results: 747 patients with a non-lacunar ischemic stroke (mean age 77±11 years, 61% females) were included. HT was observed in 94 patients (13%); they were older (82±8 vs 77±11; p 0.0001), had higher prevalence of hypertension (94% vs 81%; p 0.003) and AF (45% vs 20%; p 0.0001), and lower e-GFR (56±29 vs 65±27 ml/min/1.73 m2; p 0.04). They also had higher on-admission SBP (168±30 vs 146±23 mmHg; p 0.0001), DBP (88±18 vs 81±13 mmHg; p 0.0001) and PP (78±23 vs 63±21 mmHg; p 0.0001); anticoagulant therapy was more frequent in this group (27% vs 12%; p 0.0001). After adjusting by age and vascular risk factors in the multivariable analysis: the age > 80 years, PP on admission > 60 mm de Hg, e-GFR < 60 ml /min/1,73 m2 and pre-stroke AF were associated with increase of risk of HT. (table)
Conclusion: predictors for HT in our cohort were also related with severe vascular disease. Identification of these high risk patients is crucial in clinical decision making regarding thrombolytic treatment and optimal timing for antithrombotic therapy initiation.