Early and Late Mortality of Spontaneous Hemorrhagic Transformation of Ischemic Stroke
Early and Late Mortality of Spontaneous Hemorrhagic Transformation of Ischemic Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2013.06.005
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发表时间：
2014-04-01
影响因子：
2.5
通讯作者：
Aridon, Paolo
中科院分区：
文献类型：
--
作者：
D'Amelio, Marco;Terruso, Valeria;Aridon, Paolo
背景：出血性转化（HT）是缺血性卒中（IS）的并发症，可能影响患者的预后。我们的目的是评估，在一个以医院为基础的一系列未接受溶栓治疗的患者中，HT与死亡率之间的关系。方法：我们比较了自发性HT患者与非自发性HT患者的死亡率。回顾性分析了诊断为前部IS的患者的病历。结果指标为IS发作后30天和90天生存率。Kaplan-Meier估计用于构建生存曲线。使用考克斯比例风险模型估计主要结局指标（死亡）的风险比（HR）。HT在出血性梗死和实质血肿（PH）中分层。我们还评估了HT与主要死亡风险因素（性别、年龄、病前状态、卒中严重程度和放射学特征）之间的关系。结果：卒中发病后30天，8.1%（19/233）的患者死亡。在多变量分析中，PH（HR：7.7，95%置信区间[CI]：2.1，27.8）和入院时意识水平低（HR：5.0，95% CI：1.3，18.6）与死亡显著相关。3个月随访时，死亡率为12.1%（28/232）。在多变量分析中，大梗死面积（HR：2.7，95% CI：1.2，6.0）和HT（HR：2.3，95% CI：1.0，5.4）是死亡率的独立危险因素。然而，脑实质血肿是晚期死亡率的最强预测因子（HR：7.9，95% CI：2.9，21.4）。结论：神经功能状态和梗死面积分别在IS后早期和晚期死亡率中起重要作用。脑实质血肿可独立预测早期和晚期死亡率。
Background: Hemorrhagic transformation (HT), a complication of ischemic stroke (IS), might influence patient's prognosis. Our aim is to evaluate, in a hospital-based series of patients not treated with thrombolysis, the relationship between HT and mortality. Methods: We compared mortality of individuals with spontaneous HT with that of individuals without. Medical records of patients diagnosed with anterior IS were retrospectively reviewed. Outcome measures were 30- and 90-day survival after IS onset. Kaplan-Meier estimates were used to construct survival curves. Cox proportional hazards model was used to estimate hazard ratio (HR) for the main outcome measure (death). HT was stratified in hemorrhagic infarction and parenchymal hematoma (PH). We also evaluated the relationship between HT and the main mortality risk factors (gender, age, premorbid status, severity of stroke, and radiological features). Results: Thirty days from stroke onset, 8.1% (19 of 233) of patients died. At multivariate analysis, PH (HR: 7.7, 95% confidence interval [CI]: 2.1, 27.8) and low level of consciousness at admission (HR: 5.0, 95% CI: 1.3, 18.6) were significantly associated with death. At 3-month follow-up, mortality rate was 12.1% (28 of 232). At multivariate analysis, large infarct size (HR: 2.7, 95% CI: 1.2, 6.0) and HT (HR: 2.3, 95% CI: 1.0, 5.4) were independent risk factors for mortality. Parenchymal hematoma was, however, the strongest predictor of late mortality (HR: 7.9, 95% CI: 2.9, 21.4). Conclusions: Neurological status and infarct size play a significant role, respectively, in early and late mortality after IS. Parenchymal hematoma independently predicts both early and late mortality.