Study on the Risk Factors of Bleeding Transformation and Poor Prognosis in Acute Cerebral Infarction Patients after Emergency Thrombolysis

Abstract

To explore the risk factors of bleeding transformation and poor 90 d prognosis in acute cerebral infarction patients after emergency thrombolysis. A total of 576 acute cerebral infarction patients treated with thrombolytic therapy in emergency department from July 2018 to February 2021 were analyzed retrospectively. They were divided into groups according to the bleeding transformation and 90 d prognosis after treatment, including 92 patients with bleeding transformation and 244 patients with poor 90 d prognosis. The general data, treatment-related indicators and laboratory indicators of patients in each group were compared and logistic regression model was used to evaluate the independent risk factors of bleeding transformation and poor 90 d prognosis. The incidence of bleeding transformation after thrombolytic therapy in emergency department was 15.97 % (92/576). In the hemorrhagic transformation group, the proportion of patients with moderate to severe leukoaraiosis, D-dimer level and urine specific gravity level were significantly higher than those in the nonhemorrhagic transformation group (p<0.05). The incidence of poor 90 d prognosis after thrombolytic therapy in emergency department was 42.36 % (244/576). The age, baseline national institutes of health stroke scale score, bleeding conversion ratio, baseline random blood glucose level, international normalized ratio, proportion of large artery occlusion, D-dimer level, fibrinogen level, prothrombin time and urine glucose ratio in poor prognosis group were significantly higher than those in good prognosis group (p<0.05). Multivariate analysis showed that moderate to severe leukoaraiosis and high D-dimer level were independent risk factors for hemorrhagic transformation in acute cerebral infarction patients after emergency thrombolysis (p<0.05). High baseline national institutes of health stroke scale score and high white blood cell count level were independent influencing factors of poor 90 d prognosis of acute cerebral infarction patients after emergency thrombolysis (p<0.05). Hemorrhagic transformation in acute cerebral infarction patients undergoing emergency thrombolytic therapy is closely related to moderate to severe leukoaraiosis and D-dimer level. While, patients with high baseline national institutes of health stroke scale score and white blood cell count have poor 90 d prognosis.