ABSTRACT

Background

Hemorrhagic transformation (HT) is a common complication of ischemic stroke. We performed this study to determine whether aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) was related to HT, as well as compare the predictive values of AAR, ALT and AST for HT in patients with ischemic stroke.

Methods

We included ischemic stroke patients within 7 days of onset. HT was identified by a follow-up imaging examination. Univariate and multivariate logistic regression models were performed to assess the association between AAR and HT. Net reclassification index (NRI) was calculated to assess the ability of AAR, AST and ALT to reclassify risks of HT.

Results

A total of 2042 (median age: 69 years; 63.2% males) patients were included in this study, of whom 232 (11.4%) were identified as HT. The receiver-operating characteristic curve analysis showed that the optimal cut-off value for AAR to predict HT was 1.22. Higher AAR (≥1.22) was an independent predictor associated with HT (OR 1.44, 95%CI 1.06–1.97, P = 0.02) after adjusting for covariates. A U-shaped dose–effect relationship was found between AAR level and HT in logistic regression model with restricted cubic splines. In addition, adding AAR to a model containing conventional risk factors significantly improved predictive power for HT (NRI: 15.4%, P = 0.027), but not for ALT (NRI: 10.3%, P = 0.141) or AST (NRI: 8.3%, P = 0.237).

Conclusions

Higher AAR was associated with an increased risk of HT after ischemic stroke. In addition, AAR might be a better biomarker for predicting HT than ALT or AST.

中文翻译：

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急性缺血性卒中患者的 AST 与 ALT 比值和出血性转化的风险。

摘要

背景

出血性转化（HT）是缺血性脑卒中的常见并发症。我们进行了这项研究以确定天冬氨酸转氨酶 (AST) 与丙氨酸转氨酶 (ALT) 比值 (AAR) 是否与 HT 相关，并比较 AAR、ALT 和 AST 对缺血性卒中患者 HT 的预测值。

方法

我们纳入了发病 7 天内的缺血性卒中患者。HT 通过后续影像学检查确定。执行单变量和多变量逻辑回归模型以评估 AAR 和 HT 之间的关联。计算净重分类指数 (NRI) 以评估 AAR、AST 和 ALT 重新分类 HT 风险的能力。

结果

本研究共纳入 2042 名（中位年龄：69 岁；63.2% 为男性）患者，其中 232 名（11.4%）被确定为 HT。受试者工作特征曲线分析表明，AAR 预测 HT 的最佳临界值为 1.22。调整协变量后，较高的 AAR（≥1.22）是与 HT 相关的独立预测因子（OR 1.44，95%CI 1.06–1.97，P = 0.02）。在限制三次样条的逻辑回归模型中发现 AAR 水平和 HT 之间存在 U 形剂量效应关系。此外，在包含传统风险因素的模型中添加 AAR 显着提高了对 HT（NRI：15.4%，P = 0.027）的预测能力，但对 ALT（NRI：10.3%，P = 0.141）或 AST（NRI：8.3%）则没有, P = 0.237)。

结论

较高的 AAR 与缺血性卒中后 HT 风险增加有关。此外，AAR 可能是比 ALT 或 AST 更好的预测 HT 的生物标志物。