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Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis

Journal of Neurology volume 261, pages 905–912 (2014)Cite this article

Abstract

Few prospective studies have examined the frequency, predictors and long-term outcomes of spontaneous hemorrhagic transformation (HT) in patients with ischemic stroke not receiving thrombolytic treatment. We prospectively enrolled a consecutive cohort of 407 patients with ischemic stroke who were admitted within one month of stroke onset. In patients who developed spontaneous HT, the area of the infarct and HT were examined by computed tomography (CT) or magnetic resonance imaging (MRI). Univariate analysis was used to correlate clinical characteristics with appearance of HT, then multivariate logistical regression was used to identify independent predictors of spontaneous HT and factors that predict 3-month prognosis of ischemic stroke. Spontaneous HT was observed in 50 patients (12.3 %), comprising 33 cases (66 %) of hemorrhagic infarction, 17 (34 %) of parenchymal hematoma, 32 (64 %) of non-symptomatic HT, and 18 (36 %) of symptomatic HT. In 40 % of HT cases, the condition was detected by CT or MRI within 4–7 days of symptom onset. Multivariate logistic regression identified atrial fibrillation (OR 4.88, 95 % CI 1.83–13.00, P = 0.002) and infarct area (OR 4.48, 95 % CI 1.85–10.85, P = 0.001) as independent predictors of HT in ischemic stroke. Multivariate analysis also found that spontaneous HT was not independently associated with a worse 3-month prognosis for ischemic stroke (OR 1.59, 95 % CI 0.38–6.69, P = 0.527). Spontaneous HT occurred in 12.3 % of our patients with ischemic stroke, and atrial fibrillation and large infarct area were independent predictors. Spontaneous HT was not an independent predictor of a worse 3-month prognosis for ischemic stroke.

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Acknowledgments

The Research Fund for the Doctoral Program of Higher Education in China (20030610085).

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

This study was approved by the Scientific Research Department of West China hospital, which conformed to the local ethical criteria for research. And all patients gave informed consent for participation in the registry.

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Affiliations

  1. Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Song Tan, Deren Wang, Ming Liu, Shihong Zhang, Bo Wu & Bian Liu

  2. Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, People’s Republic of China

    Song Tan

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  1. Song Tan
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  2. Deren Wang
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  3. Ming Liu
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  5. Bo Wu
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  6. Bian Liu
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Corresponding author

Correspondence to Ming Liu.

Additional information

S. Tan and D. Wang contributed equally to this study.

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Tan, S., Wang, D., Liu, M. et al. Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis. J Neurol 261, 905–912 (2014). https://doi.org/10.1007/s00415-014-7297-8

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  • DOI: https://doi.org/10.1007/s00415-014-7297-8

Keywords

  • Frequency
  • Prevalence
  • Risk factor
  • Ischemic stroke
  • Spontaneous hemorrhagic transformation