Micro- and macroalbuminuria predict hemorrhagic transformation in acute ischemic stroke.
BACKGROUND
Hemorrhagic transformation (HT) after cerebral ischemia seems to be related to the endothelial disruption secondary to the ischemic process. Albuminuria has recently been found to be a marker of chronic endothelial damage.


OBJECTIVE
To investigate the relationship between albuminuria and HT in patients with acute ischemic stroke.


METHODS
We studied 200 patients (51.5% men, age 72.5 +/- 8.5 years) with ischemic stroke within the first 24 hours of evolution. HT development was assessed on CT performed between days 4 and 7 of evolution and classified according to the ECASS II criteria. Urinary samples were collected within the first 3 hours after admission and the presence of albuminuria, which was considered to be present when the ratio albumin-to-creatinine was > or =30 mg/g creatinine, was determined by nephelometry within the first 24 hours of evolution.


RESULTS
Forty-nine patients (24.5%) had albuminuria and 36 (18%) had HT on the second CT scan. After adjusting for potential confounders including a previous history of diabetes mellitus, hypertension and atrial fibrillation, stroke severity, the presence of early signs of ischemia and leukoaraiosis on the baseline CT scan, and IV anticoagulant treatment, logistic regression analysis showed that albuminuria was independently associated with HT (OR, 7.45; 95% CI 2.30 to 24.16). Moreover, albuminuria was also a significant and independent predictor of parenchymal hemorrhage type 1 and 2 (OR, 8.30; 95% CI 1.77 to 38.89).


CONCLUSIONS
Albuminuria is an independent predictor of hemorrhagic transformation, and particularly of the most severe bleedings, in patients with acute ischemic stroke. Due to the small number of events, the predictive capacity of albuminuria should be confirmed in larger studies.
Rodríguez-Yáñez
M
M
Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Spain.
Castellanos
M
M
Blanco
M
M
Millán
M
M
Nombela
F
F
Sobrino
T
T
Lizasoain
I
I
Leira
R
R
Serena
J
J
Dávalos
A
A
Castillo
J
J
D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000453:epidemiology*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013223:Statistics as Topic; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*