Influencing Factors and Predictive Model Construction of Hemorrhagic Transformation After Thrombolytic Therapy in Elderly Patients with Acute Cerebral Infarction

XIE Quan; ZHONG Zhendong; ZENG Yanjiao; ZHU Ying

Abstract：Objective To investigate the risk factors of cerebral hemorrhage transformation(HT)in elderly patients with acute cerebral infarction(ACI)after thrombolytic therapy.Methods 159 elderly ACI patients who received thrombolytic therapy in Xunwu County People's Hospital from May 2021 to December 2023 were selected,the general clinical data of the patients were collected,according to the results of head CT examination 48 hours after thrombolysis,patients were divided into HTgroup(36 cases)and non-HTgroup(123 cases),the related factors of HT in elderly ACI patients after thrombolysis were explored by univariate and multivariate Logistic regression analysis,and a multi-factor combined application model was constructed,the predictive value of relevant indicators and prediction models were explored by receiver operating characteristic(ROC)curve analysis.The difference of area under the ROC area under curve(AUC)was compared by Delong test.Results Univariate analysis showed that neutrophil/lymphocyte ratio(NLR),albumin(ALB),homocysteine(HCY),hemoglobin(HB),systolic blood pressure,diastolic blood pressure,National Institutes of Health Stroke Scale(NIHSS)score and history of hypertension were related to the occurrence of HT after thrombolysis in elderly ACI patients(P＜0.05).Multivariate regression showed that NLR and HCY were risk factors for HT after thrombolytic therapy in elderly ACI patients(OR＞1,P＜0.05),while HB was protective factor for HTafter thrombolytic therapy in elderly ACI patients(OR＜1,P＜0.05).ROC analysis showed that NLR,HCY and HB had certain predictive efficiency,and their AUC(95％CI)was 0.714(0.469-0.950),0.740(0.560-0.921)and 0.717(0.467-0.961),respectively.The predictive value of the combined application model was higher,with an AUC(95％CI)of 0.858(0.787-0.924).Conclusion There are more HT factors after thrombolysis in ACI patients,and the prognosis is poor.The increase of NLR and HCY levels and the decrease of HB levels will increase the risk of HT.At the same time,the combined prediction model constructed in this study has high predictive efficacy for the risk of HT in ACI patients,and can be applied to the risk identification of HT in elderly ACI patients after thrombolytic therapy.