title: Early and late mortality of spontaneous hemorrhagic transformation of ischemic stroke.
abstract: BACKGROUND
  Hemorrhagic transformation (HT), a complication of ischemic stroke (IS), might influence patient's prognosis. Our aim is to evaluate, in a hospital-based series of patients not treated with thrombolysis, the relationship between HT and mortality.
  
  
  METHODS
  We compared mortality of individuals with spontaneous HT with that of individuals without. Medical records of patients diagnosed with anterior IS were retrospectively reviewed. Outcome measures were 30- and 90-day survival after IS onset. Kaplan-Meier estimates were used to construct survival curves. Cox proportional hazards model was used to estimate hazard ratio (HR) for the main outcome measure (death). HT was stratified in hemorrhagic infarction and parenchymal hematoma (PH). We also evaluated the relationship between HT and the main mortality risk factors (gender, age, premorbid status, severity of stroke, and radiological features).
  
  
  RESULTS
  Thirty days from stroke onset, 8.1% (19 of 233) of patients died. At multivariate analysis, PH (HR: 7.7, 95% confidence interval [CI]: 2.1, 27.8) and low level of consciousness at admission (HR: 5.0, 95% CI: 1.3, 18.6) were significantly associated with death. At 3-month follow-up, mortality rate was 12.1% (28 of 232). At multivariate analysis, large infarct size (HR: 2.7, 95% CI: 1.2, 6.0) and HT (HR: 2.3, 95% CI: 1.0, 5.4) were independent risk factors for mortality. Parenchymal hematoma was, however, the strongest predictor of late mortality (HR: 7.9, 95% CI: 2.9, 21.4).
  
  
  CONCLUSIONS
  Neurological status and infarct size play a significant role, respectively, in early and late mortality after IS. Parenchymal hematoma independently predicts both early and late mortality.
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy. Electronic address: marco.damelio@unipa.it.
authors.forename: Marco
authors.initials: M
authors.lastname: D'Amelio
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Terruso
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Famoso
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Norma
authors.initials: N
authors.lastname: Di Benedetto
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Realmuto
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Valentino
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ragonese
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Savettieri
authors.affiliation: Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Aridon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin
keywords: Ischemic stroke; epidemiology; hemorrhagic transformation; prognosis; survival