Abstract Body: Background: A novel inflammatory score has been validated for hematoma expansion and poor outcomes in patients with intracerebral hemorrhage. This study aimed to explore its capacity of predicting hemorrhagic transformation risk and prognosis in patients suffering ischemic stroke.
Method: We retrospectively analyzed ischemic stroke patients in three clinical centers from 1 January 2012 to 31 December 2023 based on hospital electronic case records. A matched case-control study was conducted for reducing the impact of various confounding factors. Inflammatory score (0-9) was developed with the combination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, lactate dehydrogenase, and C-reactive protein. Logistic regression models were used for exploring the association between inflammatory score and hemorrhagic transformation and poor outcomes. Additionally, receiver operating characteristic analysis facilitate to find an optimal cutoff point of inflammatory score in developmental cohort and then confirmed in the validation cohort.
Result: A total of 426 stoke patients from three clinical centers were enrolled. Inflammatory score was significantly higher in patients with hemorrhagic transformation. The multivariate logistic regression analysis revealed inflammatory score was independently associated with severe ECASS (European Cooperative Acute Stroke Study) classification, in-hospital infection, reperfusion failure and poor modified Rankin scale (4-6). Moreover, inflammatory score greater than or equal to 5 was selected as the optimal cutoff point, which was consistent with results from a previous intracerebral hemorrhagic study. Additional, the increased inflammatory scores have been obserbed in intracranial hemorrhage potentially secondary to uncommon causes, such as infective endocarditis, cerebral amyloid angiopathy and tumor.
Conclusion: The inflammatory score can predict early hemorrhagic transformation risk and prognosis in patients with ischemic stroke. Besides, the score might imply cetain uncommon cause of intracranial hemorrhage as well.