Zhongguo quanke yixue (Aug 2022)
Relationship between Stress Hyperglycemia Ratio and Hemorrhagic Transformation Patients after Intravenous Thrombolysis in Acute Ischemic Stroke
Abstract
Background Hemorrhagic transformation (HT) is a common complication after intravenous thrombolysis in acute ischemic stroke (AIS), but biomarkers for predicting HT are currently lacking. There is a certain correlation between stress hyperglycemia ratio (SHR) and HT of AIS, but whether SHR is related to the hemorrhagic transformation after intravenous thrombolysis is not very clear. Objective To investigate the relationship between SHR and HT after intravenous thrombolysis in patients with AIS. Methods A total of 320 patients who received recombinant tissue plasminogen activator thrombolytic therapy in Ningbo Medical Center Lihuili Hospital from January 2018 to June 2021 were selected. The clinical data was collected and the value of SHR was calculated. The patients were divided into hemorrhagic transformation group (n=58) and non-hemorrhagic transformation group (n=262) according to the CT/MRI results during the acute period. The demographic data, past medical history, laboratory examination and other clinical data were compared between HT group and non-HT group. Multivariate Logistic regression analysis was used to explore the influencing factors of hemorrhagic transformation in patients with AIS after intravenous thrombolysis; according to the third quartile of SHR, the patients were divided into low SHR group (n=236) and high SHR group (n=84), and the incidence of hemorrhagic transformation was compared between the two groups; according to whether AIS patients had diabetes, the patients were divided into diabetes group (n=79) and non-diabetic group (n=241), and then according to the third quartile of SHR, the groups were divided into low SHR subgroup and high SHR subgroup to explore the influence of diabetes on the relationship between SHR and hemorrhagic transformation. Results Age, baseline National Institutes of Health Stroke Scale (NIHSS) score, percentage of atrial fibrillation, and SHR in the hemorrhagic transformation group were higher than those in the non-hemorrhagic transformation group (P<0.05). Multivariate Logistic regression analysis showed that the baseline NIHSS score〔OR=1.041, 95%CI (1.003, 1.080) 〕 and SHR〔OR=3.328, 95%CI (1.304, 8.491) 〕 were the influencing factors of acute hemorrhagic transformation after intravenous thrombolysis in AIS patients (P<0.05). The incidence of hemorrhagic transformation in the high SHR group〔29.76% (25/84) 〕 was higher than that in the low SHR group〔13.98% (33/236) 〕 (P<0.05). After adjusting age, baseline NIHSS score, and atrial fibrillation as control variables, multivariate Logistic regression analysis showed that high SHR was an risk factor for acute hemorrhagic transformation in patients with AIS after intravenous thrombolysis〔OR=2.244, 95%CI (1.215, 4.146), P=0.010〕. In the diabetes group, the incidence of HT in the high SHR subgroup〔36.00% (9/25) 〕 was higher than that in the low SHR subgroup〔14.81% (8/54) 〕 (P<0.05). In the non-diabetic group, the incidence of HT in the high SHR subgroup〔28.81% (17/59) 〕 was higher than that in the low SHR subgroup〔13.19% (24/182) 〕 (P<0.05) . Conclusion High SHR is an independent risk factor of hemorrhagic transformation after intravenous thrombolysis of AIS, and has nothing to do with diabetes.
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