Early hemorrhagic transformation of brain infarction

Rate, predictive factors, and influence on clinical outcome: Results of a prospective multicenter study

Maurizio Paciaroni, Giancarlo Agnelli, Francesco Corea, Walter Ageno, Andrea Alberti, Alessia Lanari, Valeria Caso, Sara Micheli, Luca Bertolani, Michele Venti, Francesco Palmerini, Sergio Biagini, Giancarlo Comi, Paolo Previdi, Giorgio Silvestrelli

Research output: Contribution to journalArticle

229 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT. METHODS: Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5±2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (ĝ‰¥3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases. Outcomes in patients with and without early HT were compared by X2 test. Multiple logistic regression analysis was used to identify predictors for HT. RESULTS: Among 1125 consecutive patients (median age 76.00 years), 98 (8.7%) had HT, 62 (5.5%) had hemorrhagic infarction, and 36 (3.2%) parenchymal hematoma. At 3 months, 455 patients (40.7%) were disabled or died. Death or disability was seen in 33 patients with parenchymal hematoma (91.7%), in 35 patients with hemorrhagic infarction (57.4%) as compared with 387 of the 1021 patients without HT (37.9%). At logistic regression analysis, parenchymal hematoma, but not hemorrhagic infarction, was independently associated with an increased risk for death or disability (OR 15.29; 95% CI 2.35 to 99.35). At logistic regression analysis, parenchymal hematoma was predicted by large lesions (OR 12.20, 95% CI 5.58 to 26.67), stroke attributable to cardioembolism (OR 5.25; 95% CI 2.27 to 12.14) or to other causes (OR 6.77; 95% CI 1.75 to 26.18), high levels of blood glucose (OR 1.01; 95% CI 1.00 to 1.01), and thrombolytic treatment (OR 3.54, 95% CI 1.04 to 11.95). CONCLUSIONS: Early HT occurs in about 9% of patients. Parenchymal hematoma, seen in about 3% of patients, is associated with an adverse outcome. Parenchymal hematoma was predicted by large lesions attributable to cardioembolism or other causes, high blood glucose, and treatment with thrombolysis.

Original languageEnglish
Pages (from-to)2249-2256
Number of pages8
JournalStroke
Volume39
Issue number8
DOIs
Publication statusPublished - Aug 1 2008

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Brain Infarction
Multicenter Studies
Prospective Studies
Hematoma
Stroke
Infarction
Logistic Models
Regression Analysis
Blood Glucose

Keywords

  • Hemorrhagic infarction
  • Ischemic stroke
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialised Nursing
  • Medicine(all)

Cite this

Early hemorrhagic transformation of brain infarction : Rate, predictive factors, and influence on clinical outcome: Results of a prospective multicenter study. / Paciaroni, Maurizio; Agnelli, Giancarlo; Corea, Francesco; Ageno, Walter; Alberti, Andrea; Lanari, Alessia; Caso, Valeria; Micheli, Sara; Bertolani, Luca; Venti, Michele; Palmerini, Francesco; Biagini, Sergio; Comi, Giancarlo; Previdi, Paolo; Silvestrelli, Giorgio.

In: Stroke, Vol. 39, No. 8, 01.08.2008, p. 2249-2256.

Research output: Contribution to journalArticle

Paciaroni, M, Agnelli, G, Corea, F, Ageno, W, Alberti, A, Lanari, A, Caso, V, Micheli, S, Bertolani, L, Venti, M, Palmerini, F, Biagini, S, Comi, G, Previdi, P & Silvestrelli, G 2008, 'Early hemorrhagic transformation of brain infarction: Rate, predictive factors, and influence on clinical outcome: Results of a prospective multicenter study', Stroke, vol. 39, no. 8, pp. 2249-2256. https://doi.org/10.1161/STROKEAHA.107.510321
Paciaroni, Maurizio ; Agnelli, Giancarlo ; Corea, Francesco ; Ageno, Walter ; Alberti, Andrea ; Lanari, Alessia ; Caso, Valeria ; Micheli, Sara ; Bertolani, Luca ; Venti, Michele ; Palmerini, Francesco ; Biagini, Sergio ; Comi, Giancarlo ; Previdi, Paolo ; Silvestrelli, Giorgio. / Early hemorrhagic transformation of brain infarction : Rate, predictive factors, and influence on clinical outcome: Results of a prospective multicenter study. In: Stroke. 2008 ; Vol. 39, No. 8. pp. 2249-2256.
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abstract = "BACKGROUND AND PURPOSE: Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT. METHODS: Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5±2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (ĝ‰¥3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases. Outcomes in patients with and without early HT were compared by X2 test. Multiple logistic regression analysis was used to identify predictors for HT. RESULTS: Among 1125 consecutive patients (median age 76.00 years), 98 (8.7{\%}) had HT, 62 (5.5{\%}) had hemorrhagic infarction, and 36 (3.2{\%}) parenchymal hematoma. At 3 months, 455 patients (40.7{\%}) were disabled or died. Death or disability was seen in 33 patients with parenchymal hematoma (91.7{\%}), in 35 patients with hemorrhagic infarction (57.4{\%}) as compared with 387 of the 1021 patients without HT (37.9{\%}). At logistic regression analysis, parenchymal hematoma, but not hemorrhagic infarction, was independently associated with an increased risk for death or disability (OR 15.29; 95{\%} CI 2.35 to 99.35). At logistic regression analysis, parenchymal hematoma was predicted by large lesions (OR 12.20, 95{\%} CI 5.58 to 26.67), stroke attributable to cardioembolism (OR 5.25; 95{\%} CI 2.27 to 12.14) or to other causes (OR 6.77; 95{\%} CI 1.75 to 26.18), high levels of blood glucose (OR 1.01; 95{\%} CI 1.00 to 1.01), and thrombolytic treatment (OR 3.54, 95{\%} CI 1.04 to 11.95). CONCLUSIONS: Early HT occurs in about 9{\%} of patients. Parenchymal hematoma, seen in about 3{\%} of patients, is associated with an adverse outcome. Parenchymal hematoma was predicted by large lesions attributable to cardioembolism or other causes, high blood glucose, and treatment with thrombolysis.",
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T1 - Early hemorrhagic transformation of brain infarction

T2 - Rate, predictive factors, and influence on clinical outcome: Results of a prospective multicenter study

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Corea, Francesco

AU - Ageno, Walter

AU - Alberti, Andrea

AU - Lanari, Alessia

AU - Caso, Valeria

AU - Micheli, Sara

AU - Bertolani, Luca

AU - Venti, Michele

AU - Palmerini, Francesco

AU - Biagini, Sergio

AU - Comi, Giancarlo

AU - Previdi, Paolo

AU - Silvestrelli, Giorgio

PY - 2008/8/1

Y1 - 2008/8/1

N2 - BACKGROUND AND PURPOSE: Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT. METHODS: Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5±2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (ĝ‰¥3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases. Outcomes in patients with and without early HT were compared by X2 test. Multiple logistic regression analysis was used to identify predictors for HT. RESULTS: Among 1125 consecutive patients (median age 76.00 years), 98 (8.7%) had HT, 62 (5.5%) had hemorrhagic infarction, and 36 (3.2%) parenchymal hematoma. At 3 months, 455 patients (40.7%) were disabled or died. Death or disability was seen in 33 patients with parenchymal hematoma (91.7%), in 35 patients with hemorrhagic infarction (57.4%) as compared with 387 of the 1021 patients without HT (37.9%). At logistic regression analysis, parenchymal hematoma, but not hemorrhagic infarction, was independently associated with an increased risk for death or disability (OR 15.29; 95% CI 2.35 to 99.35). At logistic regression analysis, parenchymal hematoma was predicted by large lesions (OR 12.20, 95% CI 5.58 to 26.67), stroke attributable to cardioembolism (OR 5.25; 95% CI 2.27 to 12.14) or to other causes (OR 6.77; 95% CI 1.75 to 26.18), high levels of blood glucose (OR 1.01; 95% CI 1.00 to 1.01), and thrombolytic treatment (OR 3.54, 95% CI 1.04 to 11.95). CONCLUSIONS: Early HT occurs in about 9% of patients. Parenchymal hematoma, seen in about 3% of patients, is associated with an adverse outcome. Parenchymal hematoma was predicted by large lesions attributable to cardioembolism or other causes, high blood glucose, and treatment with thrombolysis.

AB - BACKGROUND AND PURPOSE: Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT. METHODS: Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5±2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (ĝ‰¥3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases. Outcomes in patients with and without early HT were compared by X2 test. Multiple logistic regression analysis was used to identify predictors for HT. RESULTS: Among 1125 consecutive patients (median age 76.00 years), 98 (8.7%) had HT, 62 (5.5%) had hemorrhagic infarction, and 36 (3.2%) parenchymal hematoma. At 3 months, 455 patients (40.7%) were disabled or died. Death or disability was seen in 33 patients with parenchymal hematoma (91.7%), in 35 patients with hemorrhagic infarction (57.4%) as compared with 387 of the 1021 patients without HT (37.9%). At logistic regression analysis, parenchymal hematoma, but not hemorrhagic infarction, was independently associated with an increased risk for death or disability (OR 15.29; 95% CI 2.35 to 99.35). At logistic regression analysis, parenchymal hematoma was predicted by large lesions (OR 12.20, 95% CI 5.58 to 26.67), stroke attributable to cardioembolism (OR 5.25; 95% CI 2.27 to 12.14) or to other causes (OR 6.77; 95% CI 1.75 to 26.18), high levels of blood glucose (OR 1.01; 95% CI 1.00 to 1.01), and thrombolytic treatment (OR 3.54, 95% CI 1.04 to 11.95). CONCLUSIONS: Early HT occurs in about 9% of patients. Parenchymal hematoma, seen in about 3% of patients, is associated with an adverse outcome. Parenchymal hematoma was predicted by large lesions attributable to cardioembolism or other causes, high blood glucose, and treatment with thrombolysis.

KW - Hemorrhagic infarction

KW - Ischemic stroke

KW - Outcome

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