Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Risk Factors and Prediction Models of Haemorrhagic Transformation in Acute Ischaemic Stroke: A Systematic Review and Meta-analysis (#207)

Jiacheng Sun 1 2 , Christina Lam 3 4 , Lauren Christie 1 5 6 , Christopher Blair 1 2 7 , Xingjuan Li 8 , Freda Werdiger 3 4 , Qing Yang 9 , Andrew Bivard 3 4 , Longting Lin 1 2 , Mark Parsons 1 2 7
  1. Sydney Brain Centre , The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
  2. South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  3. Melbourne Brain Centre , Royal Melbourne Hospital, Melbourne, Victoria, Australia
  4. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  5. Allied Health Research Unit, St Vincent’s Health Network Sydney, Sydney, New South Wales, Australia
  6. Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia
  7. Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
  8. Queensland Department of Agriculture and Fisheries, Brisbane, Queensland, Australia
  9. Apollo Medical Imaging Technology Pty Ltd, Melbourne, Victoria, Australia

Background: Haemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis.

Aims: (1) To identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)]; (2) Evaluate the performance of model-based methods to predict HT.

Methods: Systematic review and meta-analysis. Electronic databases PubMed and EMBASE were searched. Studies were assessed for risk of bias using the Quality In Prognosis Studies tool. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated. For model-based studies, good discrimination was defined as area under curve (AUC) ≥0.7.

Results: A total of 130 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral haemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR=2.605, 95% CI 1.212–5.599, I2=0.0%) and number of thrombectomy passes (OR=1.151, 95% CI 1.041–1.272, I2=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, I2=29.1%), NIHSS score (OR=1.082, 95% CI 1.060–1.105, I2=54.5%) and onset-to-treatment time (OR=1.003, 95% CI 1.001–1.005, I2=0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR=0.686, 95% CI 0.565–0.833, I2=77.6%) and number of thrombectomy passes (OR=1.374, 95% CI 1.012–1.866, I2=86.4%) were predictors of sICH after EVT. In addition, AUC of model-based methods ranged from 0.543 to 0.957, with 46.6% (48 out of 103) achieving good discrimination.

Conclusion: Several predictors of ICH were identified, which varied by treatment type. Studies based on larger, multi-centre data sets should be prioritised.