Introducere. Evoluţia pacienţilor cu accident vascular cerebral (AVC) ischemic şi gradul de recuperare funcţională post-AVC pot fi influenţate negativ de transformarea hemor-agică (TH) a infarctului cerebral. Volumul infarctului cerebral şi severitatea clinică la internare pot afecta evoluţia pacienţilor. Scop. Evaluarea rolului volumului infarctului cerebral şi al severităţii clinice, în predicţia riscului de TH şi a recuperării funcţionale nefavorabile la externare şi la 3 luni post-AVC ischemic acut. Material şi metode. Studiul prospectiv a inclus 150 pacienţi cu AVC ischemic acut (primele 24h de la debut). Toţi pacienţii au fost monitorizaţi imagistic (tomografie computerizată cerebrală), clinic (scor NIHSS) şi funcţional (scor mRS la externare şi 3 luni post-AVC). Analiza statistică a inclus modele de regresie liniară pentru a evalua corelaţiile semnificative. Rezultate. TH a fost înregistrată la 55 de pacienţi. Scorul ASPECTS mediu la internare a fost semnificativ mai scăzut în grupul cu TH (p=0.004). Scorul NIHSS a fost semnificativ mai mare în lotul cu TH (p<0.001). Severitatea clinică la internare a fost asociată cu riscul de TH (OR=1.11, p=0.003) şi cu prognosticul funcţional nefavorabil la externare (OR=1.3, p=0.001) şi 3 luni (OR=1.17, p=0.004). La pacienţii cu scor ASPECTS mai mare, riscul de TH a fost mai redus (OR=0.77, p=0.003) şi recuperarea funcţională mai bună la externare (OR=0.52, p=0.05) şi 3 luni (OR=0.65, p=0.03). Concluzii. Datele studiului confirmă că volumul infarctului cerebral şi severitatea clinică la internare sunt factori importanţi în predicţia riscului de transformare hemoragică şi a recuperării funcţionale nefavorabile la externare şi la 3 luni post-accident vascular cerebral ischemic acut.
Introduction. The evolution of patients with ischemic stroke and the degree of functional recovery post-stroke can be negatively influenced by the development of hemorrhagic transformation (HT). The cerebral infarction volume and clinical severity at admission can affect post-stroke functional outcome. Objective. To evaluate the role of cerebral infarction volume and clinical severity in predicting the risk of HT and unfavorable functional recovery at discharge and 3 months follow-up. Material and methods. This prospective study included 150 patients with acute ischemic stroke (within 24 hours from onset). All patients were monitored through brain imaging (CT scans), clinically (NIHSS score), and functionally (mRS score at discharge and 3 months post-stroke). Statistical analysis included linear regression models to assess significant correlations. Results. HT was recorded in 55 patients. The mean ASPECTS score at admission was significantly lower in the HT group (p=0.004). The NIHSS score was significantly higher in the HT group (p<0.001). Clinical severity at admission was significantly associated with the risk of HT (OR=1.11, p=0.003) and with unfavorable functional prognosis at discharge (OR=1.3, p=0.001) and at 3 months (OR=1.17, p=0.004). Patients with higher ASPECTS scores at admission had a lower risk of HT (OR=0.77, p=0.003) and better functional recovery at discharge (OR=0.52, p=0.05) and at 3 months (OR=0.65, p=0.03). Conclusion. The obtained data from this study confirm that cerebral infarction volume and clinical severity at admission are important factors in predicting the risk of hemorrhagic transformation and unfavorable functional recovery at discharge and at 3 months post-acute ischemic stroke.
