Correlations of moderate to severe leukoaraiosis with hemorrhagic transformation and prognoses of patients with acute ischemic stroke after intravenous thrombolysis / 中华神经医学杂志

ABSTRACT

Objective:To explore the correlations of moderate to severe leukoaraiosis (LA) with hemorrhagic transformation (HT) and prognoses of patients with acute ischemic stroke after intravenous thrombolysis.Methods:Clinical data of 144 patients with acute ischemic stroke who underwent intravenous thrombolysis in our hospital from August 2017 to November 2018 were retrospectively collected. Van Swieten scale (vSS) was used to determine the leukoaraiosis degrees in these patients based on CT findings of the head before treatment. According to the CT results of head re-examination within 24 h of treatment, HT appearance of the patients was judged. The prognoses of these patients were evaluated according to modified Rankin scale (mRS) scores 90 d after discharge. Multivariate Logistic regression analysis was performed to determine the independent risk factors for HT and prognoses of patients with acute ischemic stroke after intravenous thrombolysis.Results:Among 144 patients, 23 patients (15.97%) had HT and 121 (84.03%) had non-HT; 61 patients (42.36%) were with poor prognosis and 83 (57.64%) were with good prognosis. As compared with patients in the non-HT group, patients in the HT group had significantly higher proportion of patients with moderate to severe LA, D-dimer level and urine specific gravity ( P<0.05). Multivariate Logistic regression analysis showed that moderate to severe LA ( OR=0.281, 95%CI: 0.105-0.753, P=0.012) and D-dimer ( OR=1.654, 95%CI: 1.100-2.489, P=0.016) were independent risk factors for HT. As compared with the patients in the good prognosis group, the patients in the poor prognosis group had significantly advanced age, statistically higher baseline NIHSS scores and proportion of patients with HT and positive urine sugar, significantly higher levels of random blood glucose and D-dimer, significantly higher plasma fibrinogen content, significantly higher international normalized ratio, and significantly longer plasma prothrombin time before treatment ( P<0.05). The TOAST etiological types of patients between good prognosis group and poor prognosis group were significantly different ( P<0.05). Multivariate Logistic regression analysis showed that baseline NIHSS scores ( OR=1.395, 95%CI: 1.213-1.605, P=0.000) and white blood cell count ( OR=1.292, 95%CI: 1.040-1.606, P=0.021) were independent risk factors for poor prognosis. Conclusions:Acute ischemic stroke patients with moderate to severe LA and high D-dimer are prone to HT after intravenous thrombolysis. Acute ischemic stroke patients with higher baseline NIHSS scores and peripheral white blood cell count are prone to have poor prognosis.