The predictive value of cerebral oxygen saturation combined with brain natriuretic peptide for hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke

doi:10.11958/20252420

Abstract

Abstract:

Objective To explore the predictive value of cerebral oxygen saturation combined with brain natriuretic peptide for hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke (AIS). Methods The clinical data of 120 AIS patients treated with mechanical thrombectomy were retrospectively analyzed. All patients underwent head CT examination within 24 to 72 hours after the operation and were divided into the non-hemorrhagic transformation group (66 cases) and the hemorrhagic transformation group (54 cases) according to whether hemorrhagic transformation occurred. The differences in general information, laboratory test results, cerebral oxygen saturation and serum brain natriuretic peptide levels were compared between the two groups of patients. The receiver operating characteristic (ROC) curve was used to evaluate the value of cerebral oxygen saturation combined with serum brain natriuretic peptide in predicting hemorrhage transformation after mechanical thrombectomy in AIS patients. Pearson correlation analysis was used to analyze the relationship between cerebral oxygen saturation and serum brain natriuretic peptide. Multivariate Logistic regression was used to analyze the effects of cerebral oxygen saturation and serum brain natriuretic peptide on hemorrhage transformation after mechanical thrombectomy in patients with AIS. Results The atrial fibrillation, the time from onset to admission, the National Institutes of Health Stroke Scale (NIHSS) score at admission and the serum brain natriuretic peptide level were all higher in the hemorrhagic transformation group than those in the non-hemorrhagic transformation group (P<0.05), and the cerebral oxygen saturation was lower in the hemorrhagic transformation group than that in the non-hemorrhagic transformation group (P<0.05). The cerebral oxygen saturation was negatively correlated with serum brain natriuretic peptide in AIS patients (r=-0.469, P<0.01). The optimal cut-off points of cerebral oxygen saturation combined with serum brain natriuretic peptide level for predicting hemorrhage transformation after mechanical thrombectomy in AIS patients were 55% and 239.91 ng/L, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.800 (95%CI: 0.718-0.868) and 0.832 (95%CI: 0.753-0.894), respectively. The AUC increased to 0.882 during the combined detection (95%CI: 0.810-0.934). Conclusion The decreased cerebral oxygen saturation and elevated serum brain natriuretic peptide levels are significantly associated with hemorrhage transformation after mechanical thrombectomy in AIS patients. The combination of the two has a higher predictive value and can be used as a reference index for clinical evaluation.

Key words: ischemic stroke, natriuretic peptide, brain, cerebral oxygen saturation, mechanical thrombectomy, hemorrhagic transformation

CLC Number:

R743.3，R741

Figures/Tables 4

References 22

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组别		n			性别									年龄/岁				吸烟史			饮酒史			合并糖尿病					合并高血压
组别		n			男					女				年龄/岁				吸烟史			饮酒史			合并糖尿病					合并高血压
未出血转化组		66			34（51.5）					32（48.5）				55.06±6.26				31（47.0）			27（40.9）			14（21.2）					18（27.3）
出血转化组		54			31（57.4）					23（42.6）				56.49±6.85				29（53.7）			26（48.2）			16（29.6）					19（35.2）
χ²或t					0.415									1.193				0.539			0.631			1.122					0.872
组别	合并冠心病					心房颤动			脑卒中分布							血脑屏障破坏程度							血管痉挛程度					侧支循环评分>2分
组别	合并冠心病					心房颤动			前循环闭塞				后循环闭塞			轻中度			重度				轻中度			重度		侧支循环评分>2分
未出血转化组	11（16.7）					32（48.5）			46（69.7）				20（30.3）			55（83.3）			11（16.7）				51（77.3）			15（22.7）		42（63.6）
出血转化组	13（24.1）					36（66.7）			41（75.9）				13（24.1）			49（90.7）			5（9.3）				45（83.3）			9（16.7）		39（72.2）
χ²	1.019					3.998^＊			0.578							1.410							0.682					0.998
组别				梗死核心体积/cm³				发病至血管再通时间/h				发病至入院时间/h					入院时NIHSS 评分/分					WBC/ （×10⁹/L）					TC/ （mmol/L）				TG/ （mmol/L）
未出血转化组				3.34±0.61				6.08±1.14				4.23±0.41					9.26±1.82					16.47±2.15					5.47±1.06				2.19±0.34
出血转化组				3.45±0.67				6.25±1.36				4.79±0.67					10.55±2.06					16.93±2.29					5.68±1.15				2.24±0.37
t				0.941				0.747				5.625^＊＊					3.637^＊＊					1.132					1.041				0.768
组别			CRP/（mg/L）				TNF-α/（ng/L）				Scr/（μmol/L）				血尿酸/（μmol/L）					Hb/（g/L）					脑氧饱和度/%					脑钠肽/（ng/L）
未出血转化组			20.83±2.81				32.57±6.39				179.35±19.68				313.62±24.03					136.27±17.64					62.82±8.59					226.38±14.61
出血转化组			21.35±3.12				33.17±6.76				184.56±22.35				318.25±27.61					131.44±15.43					53.57±6.46					247.95±17.22
t			0.958				0.499				1.357				0.982					1.578					6.541^＊＊					7.423^＊＊

组别		n			性别									年龄/岁				吸烟史			饮酒史			合并糖尿病					合并高血压
组别		n			男					女				年龄/岁				吸烟史			饮酒史			合并糖尿病					合并高血压
未出血转化组		66			34（51.5）					32（48.5）				55.06±6.26				31（47.0）			27（40.9）			14（21.2）					18（27.3）
出血转化组		54			31（57.4）					23（42.6）				56.49±6.85				29（53.7）			26（48.2）			16（29.6）					19（35.2）
χ²或t					0.415									1.193				0.539			0.631			1.122					0.872
组别	合并冠心病					心房颤动			脑卒中分布							血脑屏障破坏程度							血管痉挛程度					侧支循环评分>2分
组别	合并冠心病					心房颤动			前循环闭塞				后循环闭塞			轻中度			重度				轻中度			重度		侧支循环评分>2分
未出血转化组	11（16.7）					32（48.5）			46（69.7）				20（30.3）			55（83.3）			11（16.7）				51（77.3）			15（22.7）		42（63.6）
出血转化组	13（24.1）					36（66.7）			41（75.9）				13（24.1）			49（90.7）			5（9.3）				45（83.3）			9（16.7）		39（72.2）
χ²	1.019					3.998^＊			0.578							1.410							0.682					0.998
组别				梗死核心体积/cm³				发病至血管再通时间/h				发病至入院时间/h					入院时NIHSS 评分/分					WBC/ （×10⁹/L）					TC/ （mmol/L）				TG/ （mmol/L）
未出血转化组				3.34±0.61				6.08±1.14				4.23±0.41					9.26±1.82					16.47±2.15					5.47±1.06				2.19±0.34
出血转化组				3.45±0.67				6.25±1.36				4.79±0.67					10.55±2.06					16.93±2.29					5.68±1.15				2.24±0.37
t				0.941				0.747				5.625^＊＊					3.637^＊＊					1.132					1.041				0.768
组别			CRP/（mg/L）				TNF-α/（ng/L）				Scr/（μmol/L）				血尿酸/（μmol/L）					Hb/（g/L）					脑氧饱和度/%					脑钠肽/（ng/L）
未出血转化组			20.83±2.81				32.57±6.39				179.35±19.68				313.62±24.03					136.27±17.64					62.82±8.59					226.38±14.61
出血转化组			21.35±3.12				33.17±6.76				184.56±22.35				318.25±27.61					131.44±15.43					53.57±6.46					247.95±17.22
t			0.958				0.499				1.357				0.982					1.578					6.541^＊＊					7.423^＊＊

指标	最佳截断点	敏感度/%	特异度/%	AUC	95%CI
脑氧饱和度	55%	66.67	87.88	0.800	0.718~0.868
脑钠肽	239.91 ng/L	83.33	68.18	0.832	0.753~0.894
联合	-	88.89	78.79	0.882	0.810~0.934

指标	最佳截断点	敏感度/%	特异度/%	AUC	95%CI
脑氧饱和度	55%	66.67	87.88	0.800	0.718~0.868
脑钠肽	239.91 ng/L	83.33	68.18	0.832	0.753~0.894
联合	-	88.89	78.79	0.882	0.810~0.934

模型	脑氧饱和度		脑钠肽
模型	OR（95%CI）	P	OR（95%CI）	P
模型1	0.910（0.847~0.977）	0.010	1.063（1.028~1.100）	<0.001
模型2	0.904（0.840~0.973）	0.007	1.062（1.026~1.099）	<0.001
模型3	0.885（0.809~0.969）	0.008	1.065（1.020~1.113）	0.005
模型4	0.882（0.803~0.968）	0.008	1.069（1.019~1.120）	0.006