Frequency and risk factors of spontaneous hemorrhagic transformation following ischemic stroke on the initial brain CT or MRI: data from the China National Stroke Registry (CNSR).
OBJECTIVE
There are few studies of spontaneous hemorrhagic transformation (HT) after ischemic stroke (IS), and those that are available do not preclude the use of antithrombotic therapy after admission. We aimed to investigate the frequency and risk factors of spontaneous HT in patients who received no therapy between IS onset and the first instance of neurological imaging.


METHODS
We studied spontaneous HT using the China National Stroke Registry. Spontaneous HT was diagnosed on an initial computed tomography or magnetic resonance imaging scan within 14 days of IS onset. The risk factors associated with spontaneous HT were assessed using univariate analyses and multivariate logistic regression.


RESULTS
A total of 12,415 patients were diagnosed with IS, and among them, 114 (0.92%) had spontaneous HT. Multivariate analysis revealed that being female odds ratio (OR, 2.29; 95% CI, 1.52-3.44, p < 0.0001), excess alcohol consumption (OR, 2.17; 95% CI, 1.20-3.94, p = 0.0109), atrial fibrillation (OR, 2.15; 95% CI, 1.26-3.66, p = 0.0051), and a prolonged period between IS onset and initial imaging (1-7 days: OR, 1.64, 95% CI, 1.11-2.42, p = 0.0131; 7-14 days: OR, 3.12, 95% CI, 1.53-6.40, p = 0.0018) were positively associated with spontaneous HT.


CONCLUSIONS
Spontaneous HT occurred in 0.92% of the patients with IS in the acute stage. Being female, excess alcohol consumption, atrial fibrillation, and a prolonged period between IS onset and initial imaging were associated with an increased risk of spontaneous HT.
a Graduate School, North China University of Science and Technology , Tangshan , China.
Guojuan
G
Chen
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.|f Department of Epidemiology and Health Statistics , School of Public Health, Capital Medical University , Beijing , China.
Anxin
A
Wang
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.
Xingquan
X
Zhao
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.
Chunxue
C
Wang
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.
Liping
L
Liu
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.
Huaguang
H
Zheng
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.
Yongjun
Y
Wang
g Department of Neurology , Tangshan Gongren Hospital, North China University of Science and Technology , Tangshan , China.
Yibin
Y
Cao
b Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.|c China National Clinical Research Center for Neurological Diseases , Beijing , China.|d Center of Stroke, Beijing Institute for Brain Disorders , Beijing , China.|e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.
Yilong
Y
Wang
D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002681:China; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015994:Incidence; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed
Atrial fibrillation; Cerebral infarction; Risk factors; Spontaneous hemorrhagic transformation