Risk factors and serological predictors of hemorrhagic transformation of acute massive cerebral infarction

LI Yang; XU Yan; ZHAO Jilai; WANG Li; CHEN Lin; YIN Yu; CAO Shuxian

doi:10.3969/j.issn.1671-2897.2025.05.021

Abstract：Objective To analyze the risk factors and serological predictors of hemorrhagic transformation of acute massive cerebral infarction.Methods A retrospective analysis was conducted on the case data of 120 patients with acute massive cerebral infarction in the 904th Hospital of Wuxi Joint Logistic Support Force from January 2023 to January 2025.According to the occurrence of hemorrhagic transformation,42 patients with hemorrhagic transformation were included in group A,and 78 patients without hemorrhagic transformation were enrolled as group B.The clinical case data in the two groups of patients were collected.The risk factors of hemorrhagic transformation in patients with acute massive cerebral infarction were analyzed by univariate analysis and multivariate logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficiency of relevant serological indicators.Results Univariate analysis showed that group A had significantly longer time from symptom onset to treatment and higher proportion of thrombolytic therapy,proportion of atrial fibrillation history,matrix metalloproteinase(MMP)-9,D-dimer and lipoprotein-associated phospholipase A2(Lp-PLA2),and significantly lower low-density lipoprotein cholesterol(LDL-C)(P<0.05).Logistic multivariate analysis showed that long time from symptom onset to treatment,thrombolytic therapy,history of atrial fibrillation,low LDL-C level,high MMP-9 level,high D-dimer level and high Lp-PLA2 level were risk factors for hemorrhagic transformation in patients with acute massive cerebral infarction.ROC curve found that the areas under the ROC curves(AUCs)of serum MMP-9,D-dimer and Lp-PLA2 for predicting hemorrhagic transformation of acute massive cerebral infarction were 0.706,0.872 and 0.746 respectively.The AUC of combined prediction of the three serological indicators was 0.918.Conclusion In patients with acute massive cerebral infarction,the risk of hemorrhagic transformation is higher in patients with long time from symptom onset to treatment,history of thrombolytic therapy,history of atrial fibrillation,low LDL-C and high serum MMP-9,D-dimer and Lp-PLA2 levels.Serum MMP-9,D-dimer and Lp-PLA2 levels have certain predictive values on hemorrhagic transformation of acute massive cerebral infarction,and the combined predictive value is the highest.