Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis
BackgroundHemorrhagic 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 endova...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1079205/full |
| _version_ | 1797902970027769856 |
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| author | Jiacheng Sun Jiacheng Sun Christina Lam Christina Lam Lauren Christie Lauren Christie Lauren Christie Christopher Blair Christopher Blair Christopher Blair Xingjuan Li Freda Werdiger Freda Werdiger Qing Yang Andrew Bivard Andrew Bivard Longting Lin Longting Lin Mark Parsons Mark Parsons Mark Parsons |
| author_facet | Jiacheng Sun Jiacheng Sun Christina Lam Christina Lam Lauren Christie Lauren Christie Lauren Christie Christopher Blair Christopher Blair Christopher Blair Xingjuan Li Freda Werdiger Freda Werdiger Qing Yang Andrew Bivard Andrew Bivard Longting Lin Longting Lin Mark Parsons Mark Parsons Mark Parsons |
| author_sort | Jiacheng Sun |
| collection | DOAJ |
| description | BackgroundHemorrhagic 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)].MethodsElectronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated.ResultsA 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, I2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041–1.272, I2 = 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, I2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060–1.105, I2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001–1.005, I2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565–0.833, I2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012–1.866, I2 = 86.4%) were predictors of sICH after EVT.ConclusionSeveral 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 registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927. |
| first_indexed | 2024-04-10T09:25:35Z |
| format | Article |
| id | doaj.art-87f2e2d874474276b7adb77e18f6c5a1 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-10T09:25:35Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-87f2e2d874474276b7adb77e18f6c5a12023-02-20T06:05:42ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-02-011410.3389/fneur.2023.10792051079205Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysisJiacheng Sun0Jiacheng Sun1Christina Lam2Christina Lam3Lauren Christie4Lauren Christie5Lauren Christie6Christopher Blair7Christopher Blair8Christopher Blair9Xingjuan Li10Freda Werdiger11Freda Werdiger12Qing Yang13Andrew Bivard14Andrew Bivard15Longting Lin16Longting Lin17Mark Parsons18Mark Parsons19Mark Parsons20Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, AustraliaSouth Western Sydney Clinical School, University of New South Wales, Sydney, NSW, AustraliaMelbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, AustraliaDepartment of Medicine, University of Melbourne, Melbourne, VIC, AustraliaSydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, AustraliaAllied Health Research Unit, St Vincent's Health Network Sydney, Sydney, NSW, AustraliaFaculty of Health Sciences, Australian Catholic University, North Sydney, NSW, AustraliaSydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, AustraliaSouth Western Sydney Clinical School, University of New South Wales, Sydney, NSW, AustraliaDepartment of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, AustraliaQueensland Department of Agriculture and Fisheries, Brisbane, QLD, AustraliaMelbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, AustraliaDepartment of Medicine, University of Melbourne, Melbourne, VIC, AustraliaApollo Medical Imaging Technology Pty Ltd., Melbourne, VIC, AustraliaMelbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, AustraliaDepartment of Medicine, University of Melbourne, Melbourne, VIC, AustraliaSydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, AustraliaSouth Western Sydney Clinical School, University of New South Wales, Sydney, NSW, AustraliaSydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, AustraliaSouth Western Sydney Clinical School, University of New South Wales, Sydney, NSW, AustraliaDepartment of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, AustraliaBackgroundHemorrhagic 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)].MethodsElectronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated.ResultsA 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, I2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041–1.272, I2 = 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, I2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060–1.105, I2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001–1.005, I2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565–0.833, I2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012–1.866, I2 = 86.4%) were predictors of sICH after EVT.ConclusionSeveral 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 registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.https://www.frontiersin.org/articles/10.3389/fneur.2023.1079205/fullstrokerisk factorintracranial hemorrhagehemorrhagic transformationreperfusion therapyintravenous thrombolysis |
| spellingShingle | Jiacheng Sun Jiacheng Sun Christina Lam Christina Lam Lauren Christie Lauren Christie Lauren Christie Christopher Blair Christopher Blair Christopher Blair Xingjuan Li Freda Werdiger Freda Werdiger Qing Yang Andrew Bivard Andrew Bivard Longting Lin Longting Lin Mark Parsons Mark Parsons Mark Parsons Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis Frontiers in Neurology stroke risk factor intracranial hemorrhage hemorrhagic transformation reperfusion therapy intravenous thrombolysis |
| title | Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis |
| title_full | Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis |
| title_fullStr | Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis |
| title_full_unstemmed | Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis |
| title_short | Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis |
| title_sort | risk factors of hemorrhagic transformation in acute ischaemic stroke a systematic review and meta analysis |
| topic | stroke risk factor intracranial hemorrhage hemorrhagic transformation reperfusion therapy intravenous thrombolysis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1079205/full |
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