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NEUROLOGY 2006;67:1172-1177
© 2006 American Academy of Neurology

Micro- and macroalbuminuria predict hemorrhagic transformation in acute ischemic stroke

M. Rodríguez-Yáñez, MD, PhD, M. Castellanos, MD, PhD, M. Blanco, MD, PhD, M. Millán, MD, PhD, F. Nombela, MD, PhD, T. Sobrino, BsC, I. Lizasoain, MD, PhD, R. Leira, MD, PhD, J. Serena, MD, PhD, A. Dávalos, MD, PhD and J. Castillo, MD, PhD

From the Department of Neurology (M.R.-Y., M.B., T.S., R.L., J.C.), Hospital Clínico Universitario, University of Santiago de Compostela; Department of Neurology (M.C., J.S.), Hospital Universitari Doctor Josep Trueta, Girona; Department of Neurosciences (M.M., A.D.), Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona; Department of Neurology (F.N.), Hospital Universitrario de la Princesa, Madrid; and Department of Pharmacology (I.L.), Facultad de Medicina, Universidad Complutense, Madrid, Spain.

Address correspondence and reprint requests to Prof. José Castillo, Servicio de Neurología, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain; e-mail: mecasti{at}usc.es

Background: Hemorrhagic transformation (HT) after cerebral ischemia seems to be related to the endothelial disruption secondary to the ischemic process. Albuminuria has recently been found to be a marker of chronic endothelial damage.

Objective: To investigate the relationship between albuminuria and HT in patients with acute ischemic stroke.

Methods: We studied 200 patients (51.5% men, age 72.5 ± 8.5 years) with ischemic stroke within the first 24 hours of evolution. HT development was assessed on CT performed between days 4 and 7 of evolution and classified according to the ECASS II criteria. Urinary samples were collected within the first 3 hours after admission and the presence of albuminuria, which was considered to be present when the ratio albumin-to-creatinine was ≥30 mg/g creatinine, was determined by nephelometry within the first 24 hours of evolution.

Results: Forty-nine patients (24.5%) had albuminuria and 36 (18%) had HT on the second CT scan. After adjusting for potential confounders including a previous history of diabetes mellitus, hypertension and atrial fibrillation, stroke severity, the presence of early signs of ischemia and leukoaraiosis on the baseline CT scan, and IV anticoagulant treatment, logistic regression analysis showed that albuminuria was independently associated with HT (OR, 7.45; 95% CI 2.30 to 24.16). Moreover, albuminuria was also a significant and independent predictor of parenchymal hemorrhage type 1 and 2 (OR, 8.30; 95% CI 1.77 to 38.89).

Conclusion: Albuminuria is an independent predictor of hemorrhagic transformation, and particularly of the most severe bleedings, in patients with acute ischemic stroke. Due to the small number of events, the predictive capacity of albuminuria should be confirmed in larger studies.

Disclosure: The authors report no conflicts of interest.

Received December 16, 2005. Accepted in final form June 5, 2006.


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