Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background:

Whether there is a relationship between glomerular filtration rate (GFR) and hemorrhagic transformation (HT) after acute ischemic stroke (AIS) is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy (TT).

Methods:

Consecutive AIS patients without TT were included in this prospective study from January 2014 to December 2016 in the First Affiliated Hospital of Chongqing Medical University. We divided them into two groups (HT and non-HT group) and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT.

Results:

Among 426 consecutive patients, 74 (17.3%) presented HT (mean age: 65 ± 12 years, number of male patients: 47) on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR (odds ratio [ OR] = 3.708, confidence interval [ CI] = 1.326–10.693, P = 0.013), atrial fibrillation (AF; OR = 2.444, CI = 1.087–5.356, P = 0.027), large cerebral infarction ( OR = 2.583, CI = 1.236–5.262, P = 0.010), and hypoalbuminemia (HA; OR = 4.814, CI = 1.054–22.153, P = 0.037) for AIS patients without TT.

Conclusions:

The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.

摘要

背景：

肾小球滤过率是否与急性缺血性卒中患者出血转化的发生存在关联至今尚不清楚，本研究的目的是探究肾小球滤过率水平是否是非溶栓性急性缺血性卒中患者出血转化发生的预测因素。

方法：

本研究回顾性分析2014年1月至2016年12月重庆医科大学第一附属医院收治的非溶栓性缺血性卒中患者。我们将纳入人群分为两组（出血转化组与非出血转化组），并详细的收集其基本信息、实验室指标及影像学资料。采用多元回归模型分析肾小球滤过率与非溶栓性缺血性卒中患者出血性转化发生的关系。

结果：

426例纳入的患者中共74例（17.3%）在影像学随访中出现出血转化（平均年龄65±12岁，男性47例）。在多元回归分析中非溶栓性缺血性卒中患者出血转化与低肾小球滤过率（OR=3.708, CI=1.326~10.693， P=0.013），房颤（OR=2.444, CI=1.087~5.356， P =0.027），大面积脑梗死（OR=2.583, CI=1.236~5.262， P =0.010）及低蛋白血症（OR=4.814, CI=1.054~22.153， P =0.037）存在显著相关性。

结论：

本研究显示低肾小球滤过率是出血转化的独立预测因素，另外大面积脑梗死、房颤及低蛋白血症也均是非溶栓性缺血性卒中患者出血转化的重要危险因素。尽管本研究证据水平略显不高，但提出的一些有关于出血转化应当注意和消除的危险因素为预防卒中患者血转化的发生提供了实用的临床依据。

Related collections

Most cited references 49

Record: found
Abstract: found
Article: not found

Hemorrhagic transformation after ischemic stroke in animals and humans.

Boryana Stamova, DaZhi Liu, Glen Jickling … (2014)

Hemorrhagic transformation (HT) is a common complication of ischemic stroke that is exacerbated by thrombolytic therapy. Methods to better prevent, predict, and treat HT are needed. In this review, we summarize studies of HT in both animals and humans. We propose that early HT ( 18 to 24 hours after stroke) that relates to ischemia activation of brain proteases (MMP-2, MMP-3, MMP-9, and endogenous tissue plasminogen activator), neuroinflammation, and factors that promote vascular remodeling (vascular endothelial growth factor and high-moblity-group-box-1). Processes that mediate BBB repair and reduce HT risk are discussed, including transforming growth factor beta signaling in monocytes, Src kinase signaling, MMP inhibitors, and inhibitors of reactive oxygen species. Finally, clinical features associated with HT in patients with stroke are reviewed, including approaches to predict HT by clinical factors, brain imaging, and blood biomarkers. Though remarkable advances in our understanding of HT have been made, additional efforts are needed to translate these discoveries to the clinic and reduce the impact of HT on patients with ischemic stroke.

0 comments Cited 196 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Ischemia-Reperfusion Injury in Stroke

May Nour, David Liebeskind, Fabien Scalzo (2013)

Despite ongoing advances in stroke imaging and treatment, ischemic and hemorrhagic stroke continue to debilitate patients with devastating outcomes at both the personal and societal levels. While the ultimate goal of therapy in ischemic stroke is geared towards restoration of blood flow, even when mitigation of initial tissue hypoxia is successful, exacerbation of tissue injury may occur in the form of cell death, or alternatively, hemorrhagic transformation of reperfused tissue. Animal models have extensively demonstrated the concept of reperfusion injury at the molecular and cellular levels, yet no study has quantified this effect in stroke patients. These preclinical models have also demonstrated the success of a wide array of neuroprotective strategies at lessening the deleterious effects of reperfusion injury. Serial multimodal imaging may provide a framework for developing therapies for reperfusion injury.

0 comments Cited 111 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Matrix metalloproteinase-9 as a marker for acute ischemic stroke: a systematic review.

Maria Ramos-Fernandez, M. Fernanda Bellolio, Latha Stead (2011)

Matrix metalloproteinase-9 (MMP-9) is a possible marker for acute ischemic stroke (AIS). In animal models of cerebral ischemia, MMP expression was significantly increased and was related to blood-brain barrier disruption, vasogenic edema formation, and hemorrhagic transformation. The definition of the exact role of MMPs after ischemic stroke will have important diagnostic implications for stroke and for the development of therapeutic strategies aimed at modulating MMPs. The objectives of the present study were to determine (1) whether MMP-9 is a possible marker for AIS; (2) whether MMP-9 levels correlate with infarct volume, stroke severity, or functional outcome; and (3) whether MMP-9 levels correlate with the development of hemorrhagic transformation after tissue plasminogen activator (t-PA) administration. The literature was searched using MEDLINE and EMBASE with no year restriction. All relevant reports were included. A total of 22 studies (3,289 patients) satisfied the inclusion criteria. Our review revealed that higher MMP-9 values were significantly correlated with larger infarct volume, severity of stroke, and worse functional outcome. There were significant differences in MMP-9 levels between patients with AIS and healthy control subjects. Moreover, MMP-9 was a predictor of the development of intracerebral hemorrhage in patients treated with thrombolytic therapy. MMP-9 level was significantly increased after stroke onset, with the level correlating with infarct volume, stroke severity, and functional outcome. MMP-9 is a possible marker for ongoing brain ischemia, as well as a predictor of hemorrhage in patients treated with t-PA. Copyright Â© 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.

0 comments Cited 81 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Chin Med J (Engl)

Journal ID (iso-abbrev): Chin. Med. J

Journal ID (publisher-id): CMJ

Title: Chinese Medical Journal

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0366-6999

Publication date (Print): 20 July 2018

Volume: 131

Issue: 14

Pages: 1639-1644

Affiliations

[1 ]Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

[2 ]Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China

[3 ]Department of Neurology, Chengdu 363 Hospital of Southwest Medical University, Chengdu, Sichuan 610000, China

Author notes

Address for correspondence: Dr. Guang-Qin Li, Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China E-Mail: liguangqin@ 123456tom.com

Article

Publisher ID: CMJ-131-1639

DOI: 10.4103/0366-6999.235873

PMC ID: 6048938

PubMed ID: 29998881

SO-VID: 1af95b44-f30c-4282-a4e5-dbb3aeed7ced

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.