Prognostic significance of the clinical and radiological haemorrhagic transformation subtypes in acute ischaemic stroke: A systematic review and meta‐analysis

Abstract

Background and purpose:The aim was to investigate the associations of haemorrhagic transformation (HT) and its clinical and radiological subtypes with functional outcome, mortality, early neurological deterioration (END) and neurological complications in patients with acute ischaemic stroke (AIS). Methods: A systematic review and meta-analysis of observational studies on the associations of overall HT, clinical HT subtypes (asymptomatic intracerebral haemorrhage [aICH] and symptomatic intracerebral haemorrhage [sICH]) or radiological HT subtypes (haemorrhagic infarction [HI-1 or HI-2] and parenchymal haemorrhage [PH-1 or PH-2]) with prognosis in patients with AIS was performed. PubMed, Web of Science and Embase were systematically searched. Random effects models were used to calculate pooled estimates.Results: Fifty-one studies with 100,510 patients were pooled in the meta-analysis.Overall HT was associated with worse functional outcome (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.55-2.90), increased mortality (OR 1.87, 95% CI 1.52-2.30), END (OR 2.35, 95% CI 1.46-3.77), early-onset seizures (OR 2.58, 95% CI 1.63-4.10) and poststroke epilepsy (OR 2.23, 95% CI 1.11-4.49). For clinical subtypes, sICH remained significantly associated with the aforementioned poor prognoses except post-stroke epilepsy, and aICH was associated with worse functional outcome but was unrelated to mortality.For radiological subtypes, PH (especially PH-2) was strongly associated with poor prognosis. HI-2 was associated with worse functional outcome, and HI-1 was associated with a lower risk of mortality and END.Conclusions: Regardless of whether AIS patients undergo thrombolysis or thrombectomy, overall HT, sICH and PH (especially PH-2) are associated with a substantially increased risk of worse functional outcome, mortality, END or neurological complications. The presence of aICH is related to worse functional outcome but is independent of increased mortality. HI-2 impairs functional independence, and HI-1 does not cause neurological impairment.

The longitudinal changes of serum JKAP and IL‐17A, and their linkage with anxiety, depression, and cognitive impairment in acute ischemic stroke patients

“…Post‐stroke anxiety and depression are prevalent in AIS patients 26 ; however, the linkage of JKAP and IL‐17A at multiple time points after disease onset with these psychological issues in AIS patients is unclear. Therefore, the current study further evaluated this aspect and discovered the following findings.…”

“…Meanwhile, JKAP is gradually increased after treatment in rheumatoid arthritis patients 24 ; besides, JKAP is also negatively related to IL-17A in ankylosing spondylitis patients, which is in line with the current study. 23 Post-stroke anxiety and depression are prevalent in AIS patients 26 ; however, the linkage of JKAP and IL-17A at multiple time points after disease onset with these psychological issues in AIS patients is unclear. Therefore, the current study further evaluated this aspect and discovered the following findings.…”

Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients

“…The preferred treatment for patients with acute ischemic stroke (AIS) is intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator within 4.5 h of onset ( 2 , 3 ). However, such IVT may cause hemorrhagic transformation (HT), which impedes functional recovery and can even lead to death ( 4 ). About 90% of HT cases occur within 24–36 h of stroke onset ( 5 ).…”

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

“…In ammatory response, coagulation abnormalities and poor nutritional status are pathophysiological mechanisms of AIS and also predictors of poor AIS prognosis [9][10][11] . Lymphocytes have a key regulatory function in post-AIS in ammation and have been shown to be predictors of exacerbating ischemic brain injury and deteriorating neurological function [12] .…”