HAEMORRHAGIC TRANSFORMATION IN ACUTE ISCHAEMIC STROKE AND ITS IMPACT ON FUNCTIONAL DISABILITY AND MORTALITY
Background: Haemorrhagic Transformation (HT) is a common and potentially serious occurrence following acute ischaemic stroke with significant impact on patients’ outcome. Determining the predictors and its outcome will assist the management of acute stroke patients.
Materials and Methods: This was a prospective observational study, involving all acute ischaemic stroke patients admitted to University Kebangsaan Malaysia Medical Centre (UKMMC) from June 2008 to February 2009 ( n = 73). A single observer, using pre-defined diagnostic criteria recorded information on demography, assessment of stroke severity on admission and at day 30 based on National Institute of Health Stroke Scale (NIHSS) score and functional disability at day 30 based on Modified Rankin Score (MRS). Computer tomography (CT) of the brain was performed within 24 hours of presentation and followed by MRI T2*2 weighted GRE (Gradient Echo Contrast) within 7 days of the onset of stroke. Earlier imaging was done if the clinical condition suggested HT. A neuroradiologist blinded to clinical information evaluated each scan for the presence of HT.
Result: Seventy three patients with acute ischaemic stroke were enrolled in the study and 19 (26%) of them developed HT. Using Multivariate analysis, the independent predictors of HT was NIHSS > 5 (OR 0.27; 95% CI 1.021-12.704; p=0.046). In multivariate analysis, independent predictors for poor functional outcome at 30 days was severe NIHSS score on admission (OR 2.958; 95% CI 1.713 – 5.108; p <0.001) and severe Glasgow Coma Scale on admission (OR 0.132; 95% CI 0.021-0.821; p < 0.001). The presence of severe NIHSS score on admission increased 30-day mortality (OR 1.528; 95% CI 1.03-7.217; p = 0.026).
Conclusion: HT was not significant associated with poor functional outcome and mortality at 30 days. Stroke severity on admission predicts the HT development, poor functional outcome and mortality at 30-days. HT does not affect the outcome and mortality after an acute ischaemic stroke.
Keywords: acute ischaemic stroke, haemorrhagic transformation, functional disability, mortality