Analysis of influencing factors of neurological function recovery and cerebral hemorrhage transformation after intravenous thrombolysis in patients with acute ischemic stroke

Abstract

To analyze the risk factors of neurological function recovery and occurrence of cerebral hemorrhage transformation (HT) after recombinant tissue-type plasiminogen activator (re-PA) in patients with acute ischemic stroke (AIS). The 173 patients with AIS who received rt-PA thrombolysis in Changshu Hospital of Xuzhou Medical University from March, 2018 to January, 2020 were selected as research objects, and they were divided into HT group (46 cases) and non HT group (127 cases) according to whether HT occurred. The data such as gender, age, body mass index (BMI), past histories including smoking, drinking, hypertension, diabetes mellitus, stroke, atrial fibrillation, coronary heart disease, National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, systolic blood pressure before thrombolysis, diastolic blood pressure before thrombolysis, hemoglobin, blood glucose, triglyceride, total cholesterol, thrombolytic time, responsible infarction, CT low density foci, estimated glomerular filtration rate (eGFR), serum uric acid (SUA) and fibrinogen (Fib) were collected. The differences of the above indexes were compared between the HT and non HT groups and the patients with different prognosis. The factors influencing the occurrence and neurological function recovery of HT were analyzed by multivariate Logistic regression. (1) Univariate analysis showed that eGFR (mL×min-1×1.73 m-2): 87.53±14.32 vs. 121.47±32.49) and SUA (μmol/L: 324.89±70.43 vs. 383.08±89.21) in HT group were significantly lower than those in non HT group (both P < 0.05), Fib (g/L: 2.99±0.57 vs. 2.58±0.49), age (years old: 70.32±5.87 vs. 65.28±7.09), hypertension [76.1% (35/46) vs. 51.2% (65/127)], diabetes mellitus [71.7% (33/46) vs. 48.8% (62/127)], NIHSS before thrombolysis (13.42±2.97 vs. 10.18±1.85), proportion of thrombolytic time 3.0-4.5 hours [52.2% (24/46) vs. 38.6% (49/127)], and the proportion of CT low-density lesions [50.0% (23/46) vs. 22.0% (28/127)] in HT group were significantly higher than those in non HT group (all P < 0.05). In poor prognosis group, eGFR (mL×min-1×1.73 m-2: 92.08±22.37 vs. 116.59±24.57) and SUA (μmol/L: 332.58±59.03 vs. 370.34±63.46) were significantly lower than those in good prognosis group (both P < 0.05), Fib (g/L: 2.91±0.46 vs. 2.68±0.52), age (years old: 71.26±5.42 vs. 64.08±7.48), BMI (kg/m2: 24.32±3.68 vs. 23.18±3.16), the proportion of hypertension [69.7% (46/66) vs. 50.5% (54/107)], NIHSS before thrombolysis (12.98±3.02 vs. 10.32±2.14), proportion of thrombolytic time 3.0-4.5 hours [57.6% (38/66) vs. 32.7% (35/107)], proportion of CT low-density lesions [40.9% (27/46) vs. 22.4% (24/107)] were significantly higher than those in good prognosis group (all P < 0.05). (2) Multivariate Logistic regression analysis showed that SUA > 364.5 μmol/L was a protective factor for HT [odds ratio (OR) = 0.607, 95% confidence interval (95%CI) was 0.493-0.732, P = 0.012], age > 69 years old (OR = 2.470, 95%CI was 1.438-5.291, P = 0.020), NIHSS score before thrombolysis > 12 points (OR = 5.072, 95%CI was 1.793-12.468, P = 0.001), and time from onset to thrombolysis 3.0-4.5 hours (OR = 3.854, 95%CI was 1.600-5.816, P = 0.005) were independent risk factors for HT. No independent effects of eGFR and Fib on HT were observed (both P > 0.05); eGFR > 102.5 mL×min-1×1.73 m-2 (OR = 0.663, 95%CI was 0.544-0.782, P = 0.005) and SUA > 352.7 μmol/L (OR = 0.714, 95%CI was 0.603-0.825, P = 0.014) were protective factors for prognosis, and age > 70 years old (OR = 1.642, 95%CI was 1.173-3.512, P = 0.038), NIHSS score before thrombolysis (OR = 2.108, 95%CI was 1.356-4.438, P = 0.022) and HT (OR = 3.852, 95%CI was 1.819-9.054, P = 0.001) were risk factors for poor prognosis. SUA is protective factor of HT and poor prognosis in patients with AIS after intravenous thrombolysis with rt-PA, eGFR is protective factor of poor prognosis, but it has no correlation with HT, Fib before thrombolysis has no correlation with HT and poor prognosis.