Published Online
on June 5, 2008

A more recent version of this article appeared on August 1, 2008

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Submitted on November 17, 2007
Revised on December 20, 2007
Accepted on January 3, 2008

Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome. Results of a Prospective Multicenter Study

Maurizio Paciaroni MD^*; Giancarlo Agnelli MD; Francesco Corea MD, PhD; Walter Ageno MD; Andrea Alberti MD; Alessia Lanari MD; Valeria Caso MD, PhD; Sara Micheli MD; Luca Bertolani MD; Michele Venti MD, PhD; Francesco Palmerini MD; Sergio Biagini MD; Giancarlo Comi MD; Paolo Previdi MD; and Giorgio Silvestrelli MD, PhD

From the Stroke Unit, Division of Cardiovascular Medicine (M.P., G.A., A.A., V.C., M.V., F.P., S.B.), University of Perugia, Italy; the Stroke Unit, Division of Neurology (A.L., L.B., P.P., G.S.), Carlo Poma Hospital, Mantova, Italy; the Stroke Unit (F.C., S.M., G.C.), San Raffaele Hospital, University of Milan, Italy; and the Department of Clinical Medicine (W.A.), University of Insubria, Varese, Italy.

^* To whom correspondence should be addressed. E-mail: mpaciaroni{at}med.unipg.it.

Background and Purpose—Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT.

Methods—Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5±2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases. Outcomes in patients with and without early HT were compared by ² test. Multiple logistic regression analysis was used to identify predictors for HT.

Results—Among 1125 consecutive patients (median age 76.00 years), 98 (8.7%) had HT, 62 (5.5%) had hemorrhagic infarction, and 36 (3.2%) parenchymal hematoma. At 3 months, 455 patients (40.7%) were disabled or died. Death or disability was seen in 33 patients with parenchymal hematoma (91.7%), in 35 patients with hemorrhagic infarction (57.4%) as compared with 387 of the 1021 patients without HT (37.9%). At logistic regression analysis, parenchymal hematoma, but not hemorrhagic infarction, was independently associated with an increased risk for death or disability (OR 15.29; 95% CI 2.35 to 99.35). At logistic regression analysis, parenchymal hematoma was predicted by large lesions (OR 12.20, 95% CI 5.58 to 26.67), stroke attributable to cardioembolism (OR 5.25; 95% CI 2.27 to 12.14) or to other causes (OR 6.77; 95% CI 1.75 to 26.18), high levels of blood glucose (OR 1.01; 95% CI 1.00 to 1.01), and thrombolytic treatment (OR 3.54, 95% CI 1.04 to 11.95).

Conclusions—Early HT occurs in about 9% of patients. Parenchymal hematoma, seen in about 3% of patients, is associated with an adverse outcome. Parenchymal hematoma was predicted by large lesions attributable to cardioembolism or other causes, high blood glucose, and treatment with thrombolysis.

Key words: hemorrhagic infarction • ischemic stroke • outcome

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