Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis

Jiacheng Sun; Christina Lam; Lauren Christie; Christopher Blair; Xingjuan Li; Freda Werdiger; Qing Yang; Andrew Bivard; Longting Lin; Mark Parsons

doi:10.3389/fneur.2023.1079205

Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis

Front Neurol. 2023 Feb 20:14:1079205. doi: 10.3389/fneur.2023.1079205. eCollection 2023.

Authors

Jiacheng Sun^{1

2}, Christina Lam^{3

4}, Lauren Christie^{1

5

6}, Christopher Blair^{1

2

7}, Xingjuan Li⁸, Freda Werdiger^{3

4}, Qing Yang⁹, Andrew Bivard^{3

4}, Longting Lin^{1

2}, Mark Parsons^{1

2

7}

Affiliations

¹ Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
² South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
³ Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.
⁴ Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
⁵ Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, NSW, Australia.
⁶ Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia.
⁷ Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia.
⁸ Queensland Department of Agriculture and Fisheries, Brisbane, QLD, Australia.
⁹ Apollo Medical Imaging Technology Pty Ltd., Melbourne, VIC, Australia.

Abstract

Background: Hemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)].

Methods: Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated.

Results: A total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212-5.599, I ² = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041-1.272, I ² = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970-7.591, I ² = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060-1.105, I ² = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001-1.005, I ² = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565-0.833, I ² =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012-1.866, I ² = 86.4%) were predictors of sICH after EVT.

Conclusion: Several predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.

Keywords: endovascular thrombectomy; hemorrhagic transformation; intracranial hemorrhage; intravenous thrombolysis; reperfusion therapy; risk factor; stroke.

Publication types

Systematic Review