AUTHOR=Sun Jiacheng , Lam Christina , Christie Lauren , Blair Christopher , Li Xingjuan , Werdiger Freda , Yang Qing , Bivard Andrew , Lin Longting , Parsons Mark 

TITLE=Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1079205

DOI=10.3389/fneur.2023.1079205

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>Hemorrhagic 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)].</p></sec><sec><title>Methods</title><p>Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated.</p></sec><sec><title>Results</title><p>A 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, <italic>I</italic><sup>2</sup> = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041–1.272, <italic>I</italic><sup>2</sup> = 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, <italic>I</italic><sup>2</sup> = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060–1.105, <italic>I</italic><sup>2</sup> = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001–1.005, <italic>I</italic><sup>2</sup> = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565–0.833, <italic>I</italic><sup>2</sup> =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012–1.866, <italic>I</italic><sup>2</sup> = 86.4%) were predictors of sICH after EVT.</p></sec><sec><title>Conclusion</title><p>Several 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.</p></sec><sec><title>Systematic review registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927</ext-link>, identifier: CRD42021268927.</p></sec>