BACKGROUND AND PURPOSE Hemorrhagic transformation (HT) is a common neurological complication after ischemic stroke. The influence of symptomatic HT upon clinical outcomes post-stroke is well established, however, the role of asymptomatic HT upon prognosis is still unclear. We aimed to analyze the relationship between HT, clinical complications and outcomes in patients not submitted to reperfusion therapies (RT). METHODS We included 448 randomly selected patients admitted with acute ischemic stroke to a tertiary hospital stroke unit from 2015 to 2017. Patients submitted to RT were excluded. All patients were evaluated with computed tomography (CT) at admission and within 7 days from the initial CT. Patients with HT were divided into two groups: symptomatic and asymptomatic cases based on the ECASS II definition. A good clinical outcome was defined as a modified Rankin Scale (mRS) 0-2 at discharge. RESULTS A total of 95 patients (21.2%) had HT (51 asymptomatic and 44 symptomatic). Age, NIHSS at admission and symptomatic HT were associated with a higher risk of developing pneumonia and seizures during hospitalization. Symptomatic HT was also associated with a prolonged length of hospitalization and death and inversely associated with good clinical outcomes at discharge (OR 0.96, 95% CI 0.94-0.98, p<0.001). In an adjusted analysis, even asymptomatic HT was independently associated with worse clinical outcomes at discharge (mRS 4-6) (OR 5.99, 95% CI 1.83-19.58, p = 0.003). CONCLUSIONS Symptomatic HT is associated with a higher risk of clinical complications, prolonged hospitalization, death and worse clinical outcome at discharge. Furthermore, even patients with asymptomatic HT had a higher chance of worse clinical outcomes at discharge.

中文翻译：

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在临床并发症和结果中，出血性转化在急性缺血性卒中中的作用。

背景与目的出血性转化（HT）是缺血性中风后常见的神经系统并发症。有症状的HT对中风后临床结局的影响已得到充分证实，但是，无症状的HT对预后的作用尚不清楚。我们旨在分析未接受再灌注治疗（RT）的患者的HT，临床并发症和预后之间的关系。方法我们将2015年至2017年随机选择的448例急性缺血性卒中患者纳入三级医院卒中病房，排除接受RT的患者。所有患者均在入院时和首次CT后7天内进行了计算机断层扫描（CT）评估。根据ECASS II定义，HT患者分为两组：有症状和无症状。出院时将改良的Rankin量表（mRS）0-2定义为良好的临床结果。结果共有95例患者（21.2％）患有HT（51例无症状和44例有症状）。年龄，住院时的NIHSS和有症状的HT与住院期间发生肺炎和癫痫发作的风险较高相关。有症状的HT还与住院和死亡时间延长有关，与出院时的良好临床结果呈负相关（OR 0.96，95％CI 0.94-0.98，p <0.001）。在调整后的分析中，即使无症状的HT也与出院时较差的临床结局独立相关（mRS 4-6）（OR 5.99，95％CI 1.83-19.58，p = 0.003）。结论有症状的HT与临床并发症，住院时间延长，死亡和出院时临床预后较差的风险较高有关。此外，