Computed Tomography imaging predictors of hemorrhagic transformation in stroke patients treated with intravenous thrombolytic drug in Krabi hospital
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Abstract
Background: Hemorrhagic Transformation is a significant complication following thrombolytic therapy in acute ischemic stroke patients, associated with disability and mortality. Early risk prediction is crucial for treatment planning and improving patient outcomes.
Objective: To identify CT imaging predictors associated with Hemorrhagic Transformation in acute ischemic stroke patients treated with intravenous thrombolysis (rt-PA), determine the incidence of Hemorrhagic Transformation, and evaluate the predictive performance of Early Ischemic CT Signs.
Methods: A retrospective cohort study was conducted among 170 acute ischemic stroke patients treated with rt-PA at Krabi Hospital, between January 2021 and February 2025. Baseline Non-contrast Computed Tomography (NCCT) was reviewed for Early Ischemic CT Signs prior to treatment. Hemorrhagic transformation was classified according to the European Cooperative Acute Stroke Study II (ECASS II) criteria. Associations between imaging findings and Hemorrhagic Transformation were analyzed using Firth’s bias-reduced logistic regression. Predictive performance was assessed using receiver operating characteristic (ROC) analysis.
Results: Hemorrhagic Transformation occurred in 12.9% of patients, while the in-hospital mortality rate was 8.8%. In univariable analyses, several Early Ischemic CT Signs were significantly associated with Hemorrhagic Transformation. After adjustment for potential confounders, Loss of Insular Ribbon remained the only independent predictor of Hemorrhagic Transformation (Adjusted OR 15.45, 95% CI 2.73–87.32; p=0.002). ROC analysis demonstrated that Loss of Insular Ribbon had the highest predictive performance, with an area under the ROC curve (AuROC) of 0.70 (95% CI 0.57–0.83), specificity of 89.9%, and a NPV of 92.4%.
Conclusion: Loss of Insular Ribbon on pretreatment NCCT was independently associated with hemorrhagic transformation following intravenous thrombolysis and showed the highest predictive performance among the evaluated imaging markers. These findings support the use of Early Ischemic CT Signs for risk stratification and post-thrombolysis monitoring, particularly in resource-limited settings where NCCT remains the primary imaging modality.
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บทความนิพนธ์ต้นฉบับจะต้องผ่านการพิจารณาโดยผู้ทรงคุณวุฒิที่เชี่ยวชาญอย่างน้อย 2 ท่าน แบบผู้ทรงคุณวุฒิ และผู้แต่งไม่ทราบชื่อกันและกัน (double-blind review) และการตีพิมพ์บทความซ้ำต้องได้รับการอนุญาตจากกองบรรณาธิการเป็นลายลักษณ์อักษร
ลิขสิทธิ์
ห้ามนำข้อความทั้งหมดหรือบางส่วนไปพิมพ์ เว้นว่าได้รับอนุญาตจากโรงพยาบาลเป็นลายลักษณ์อักษร
ความรับผิดชอบ
เนื้อหาต้นฉบับที่ปรากฏในวารสารเป็นความรับผิดชอบของผู้เขียน ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากเทคนิคการพิมพ์
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