Predictors of Hemorrhagic Transformation in Acute Ischemic Stroke Patients in Addis Ababa, Ethiopia: A Multicenter Retrospective Study

Background: Ischemic stroke is a major global cause of morbidity and mortality, disproportionately affecting low- and middle-income countries. Hemorrhagic transformation (HT) is a frequent and serious complication of acute ischemic stroke, occurring in 3.2% to 43.3% of patients and associated with increased mortality. Identifying predictors of HT is essential to improving patient outcomes. Objective: To determine clinical and demographic predictors of hemorrhagic transformation in acute ischemic stroke patients admitted to three major hospitals in Addis Ababa, Ethiopia. Methods: A retrospective case-control study was conducted on 270 adult inpatients with acute ischemic stroke at Saint Paul Hospital Millennium Medical College, Zewditu Memorial Hospital, and Tikur Anbessa Specialized Hospital between June 2019 and July 2022. Data were analyzed using SPSS version 26.0. Bivariate and multivariate logistic regression analyses identified associations between HT and potential predictors. Statistical significance was set at p < 0.05. Results: The mean age was 61.2 years, with 37.8% aged 61–70 years. History of diabetes mellitus increased the risk of HT by 5.4 times (AOR=5.4, 95% CI: 2.35–12.31, p<0.001), and stress hyperglycemia increased risk by 12.2 times (AOR=12.2, 95% CI: 2.30–65.12, p=0.003). Previous stroke or transient ischemic attack raised risk 3.7-fold (AOR=3.7, 95% CI: 1.57–8.86, p=0.003). Warfarin therapy was associated with a 13.1-fold increased risk (AOR=13.1, 95% CI: 6.91–131.62, p<0.001), and concurrent use of multiple anticoagulants increased risk 3.8-fold (AOR=3.8, 95% CI: 1.55–9.57, p=0.004). Conclusion: Anticoagulant therapy, stress hyperglycemia, prior stroke, and diabetes mellitus are significant independent predictors of hemorrhagic transformation in acute ischemic stroke. Emphasizing guideline-based management and addressing modifiable risk factors may reduce HT incidence and improve outcomes.