Abstract TP327: Predictors of Spontaneous Hemorrhagic Transformation in Patients Not Treated With Recanalization Therapies

Abstract

Hemorrhagic transformation (HT) is an important complication after ischemic stroke and might be associated with a worse clinical prognosis. Predictors of (HT) in patients treated with recanalization therapies were extensively evaluated, however predictors of spontaneous HT are less well described. Hypothesis: we evaluated the hypothesis that clinical and neuroimaging variables can predict spontaneous HT in patients with ischemic stroke. Methods: We evaluated patients admitted with ischemic stroke and not treated with recanalization therapies to a tertiary stroke center. The rates of hemorrhagic transformation were evaluated in follow up CT scans (within at least 24 hours), using the ECASS II criteria. Univariate predictors of HT were identified. We used logistic regression analysis to investigate independent predictors of HT. Results: A total of 258 patients were evaluated (mean age 64 ± 14,=6 years, 59.3% males.) The overall prevalence of HT was 21.3% (n = 55), with 45.5% (n = 25) of symptomatic HT. Patients with HT had higher NIHSS at admission (13 [10-15,5] versus 8 [4-17], p <0.01), lower ASPECTS scores (7 [6-8] 9 [8-9] p<0.01) and a trend towards being more hypertensive at admission (76.1% versus 68.1%, p=0.2). Cardio-aortic embolism was more frequent among patients with HT (39,3% versus 23,2%, p= 0.02). ASPECTS scores at admission (OR 0.60 (0.44-0.82) ≤0.01), admission glucose levels (OR 1.01 (1.01-1.01) p≤0.01), being hypertensive at admission (OR 3.03 (1.08-8.48) p=0.03) and having a previous history of coronary artery disease (OR 4.01 (1.24-12.93) p=0.02) were independent predictors of HT. Previous use of antithrombotic medications was not associated with HT. Patients with HT had a lower frequency of independence at discharge (mRS<=2), p=0.03. Symptomatic and asymptomatic HT were associated with a higher chance of death during hospitalization (OR 3.28, 95% CI 1-11.20, p= 0.05 and OR 4.61, 95% CI 1.35-15, 71, p = 0.01, respectively). Conclusion: In conclusion, HT is not uncommon in acute ischemic stroke not treated with recanalization therapies. Clinical, neuroimaging and laboratorial data characteristics can be used to identify patients at higher risk for HT. Even asymptomatic HT seems to be associated with worse clinical outcomes