PREDICTOR OF HEMORRHAGIC TRANSFORMATION OF ACUTE ISCHEMIC STROKE LESION AMONG INPATIENTS AT THREE HOSPITALS IN ADDIS ABEBA, ETHIOPIA

Abstract

Abstract Background: Ischemic stroke is a major cause of increased morbidity and mortality. Stroke incidence, prevalence, and mortality rates have all grown globally, with low- and middleincome countries bearing the most of the burden.(1) The World Health Organization reports that between 2002 and 2012, stroke was the second leading cause of mortality.(2) Hemorrhagic transformation occurs frequently in patients with acute ischemic stroke. It increases morbidity and mortality of acute ischemic stroke. Following ischemic stroke, the occurrence of spontaneous hemorrhagic transformation ranges from 3.2% to 43.3% and is fatal in around 3% of patients.(2) Objective: The study aims to assess the predictor of hemorrhagic transformation in acute ischemic stroke lesion among inpatients at three hospitals in Addis Ababa, Ethiopia. Methodology: A retrospective case control study was carried out among patients with acute ischemic stroke at Saint Paul Hospital Millennium Medical College, Zewditu Memorial Hospital and Tikur Anbessa Specialized Hospital admitted to inpatient care from June 2019 to July 2022 in order to determine the predictor of hemorrhagic transformation in acute ischemic stroke patients. The study was carried out from a sample size of 270. Data was collected from medical chart of the patient and was first checked manually for completeness and later coded and analyzed using SPSS version 26.0. Bivariate and multivariate logistic regression analysis was performed to determine the association between dependent and independent variables.The cut off point used to include variables in multivariate regression was 0.25. All tests with P-Value <0.05 were considered statistically significant. Result: In this study 37.8% of the study participants were in the age group of 61-70 years with mean and SD of 61.2±12.51 years respectively. Research participants with a history of diabetes mellitus had an increase in hemorrhagic transformation of 5.4 folds, while those with stress hyperglycemia had an increase in hemorrhagic transformation of 12.2 folds compared to the opposite compartment. Patients with previous history of stroke/ transient ischemic attack increased risk by 3.7 folds. Those who took warfarin had 13.1 increased risk and in 5.6 folds in those who took heparin. The hemorrhagic transformation risk of study participants taking one or more anticoagulant medications was 3.8 fold higher than that of research participants taking just one prescription. Conclusion: Study participants with diabetes mellitus, stress hyperglycemia, previous history of stroke/ transient ischemic attack, taking one and above anticoagulant medication, heparin and warfarin had a significant association. Recommendations: Guideline based acute ischemic stroke management; targeted interventions should focus on reducing modifiable risk factors like diabetes mellitus,dyslipedemia, further studies should be conducted to better understand factors associated with increased risk of hemorrhagic transformation.